The Tyranny of Faux Self-Care

A bath bomb will not cure....pretty much anything

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I have a faux self-care origin story. It happened sometime cutting a vacation short to race to report on the mass shooting in Sutherland Springs, Texas, then heading straight to report on the women who’d left the FLDS sect in Short Creek, Utah, and then writing about Armie Hammer and having trolls threaten to cut the throat of my dog, and then returning to Texas to follow the end days before the 2018 midterms. I came home, existentially exhausted and incapable of focus, scheduled a 60 minute massage and a facial, and thought: this will fix everything.

BAHAHAHAHAHAHAHAHAHAHAHAHAAHHAHAHAHAHAHAH, which is another way of saying, no, it so very much did not fix everything. The malaise I felt in the aftermath led to the piece on millennial burnout that launched my career in a very different direction. It took years to truly reflect, process, and alter my life in a way that would help me arrive at something like real self-care. But the experience, and my stubborn, nonsensical confidence that a MASSAGE would somehow rectify the situation, has stuck with me. I know where it came from (buy things, you’ll be fixed, is just classic capitalist marketing) but I don’t know that I’ve read or experienced an applicable antidote, other than my own strategy of figuring out how we got here.

It’s never unhelpful to look at the structures that influence our behavior. But also helpful = talking to/reading stuff by people whose job it is to guide people through this quagmire. Dr. Pooja Lakshmin is a psychiatrist and a physician, a frequent New York Times contributor, and a Clinical Assistant Professor of Psychiatry and Behavioral Sciences at George Washington University, and her new book, Real Self-Care, acknowledges all of the structural bullshit — but is also prescriptive.

Pooja doesn’t shy from the fact that it’s a self-help book. It’s just a self-help book that, you know, understands the ways white supremacy, capitalism, and sexism affect our daily realities and options. Keep reading if this is something you don’t believe is actually possible — or, if you’re not interested in that, you might be interested in what it’s like to blow up your “perfect” life, as Pooja did in her mid-20s, and attempt to build it back in a way that feels intentional and very much her very own.

You can find Dr. Pooja Lakshmin on Instagram here, and find her website here. You can learn more about her joint newsletter centering women’s mental health here, and pre-order Real Self-Care here.

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Can we first define “faux” self-care? I’m especially interested in thinking through how “faux” self-care springs from capitalist understandings of health and well-being, aka, if you just buy this, all your problems will be fixed. 

You can’t meditate your way out of a 40-hour work week with no childcare. Buying a new planner and signing up for a meditation class won’t change the fact that +30 million Americans are uninsured and that 25% of American’s don’t have paid sick days off work. So when I say faux self-care, what I am taking about are the products and tasks that are marketed to us as the solution for “women’s” problems. Self-care as it’s marketed is devoid of substance and incapable of truly nourishing us. 

As I was writing Real Self-Care, I researched the origins of the term, and I found that there are essentially two lineages.  The first was the medical community: in the 1950s and 60’s, psychiatrists use the term self-care to describe the ways in which patients who were institutionalized on psychiatric units could exert control over their care with exercise or food choices. Nurses also talked about self-care in relation to compassion fatigue.

But the 1970s social justice movement is what really put self-care on the map. Audre Lorde’s famous words “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare” were a rallying cry for Black folks and Queers folks who were fighting for their rights. It is not an accident that we have Black Queer women thinkers to thank for crystallizing self-care as a political movement. It’s the most oppressed who so often do the heavy lifting when you live in an unjust and inequitable society. 

So where do I take this as a psychiatrist? In 2023, #selfcare on social media is just an another word for commodified wellness, and our healthcare system has just totally broken down. That was the case long before the pandemic, especially for middle-class, lower middle-class, and low income folks, immigrants, basically anyone who is marginalized by our society. It’s so much more seductive to click buy on an IG ad for a beige branded vitamin pack that claims to fix your anxiety than to do the arduous work of trying to find a therapist who actually takes insurance and doesn’t have a waiting list (good luck).  

Capitalism and white supremacy do a great job of keeping us on this hamster wheel, but the root of the problem is not, as I wrote for the New York Times, inside us. It’s not our fault we turn to Band-Aid solutions. From what I see in my clinical practice — and what I’ve lived myself — wellness “activities” end up as just one more task on the to do list to feel guilty about (if you can even afford them). They keep us looking outward — comparing ourselves with others or striving for a certain type of perfection.

So the perfect example is the patient who comes into my office (now, my Zoom room), and says, “Dr. Lakshmin, I’m not eating well, I’m not sleeping well, I know I’m burnt out, AND I feel like it’s my fault because I have this meditation app on my phone that I know I should be using!” I call this the tyranny of faux self-care. 

It’s faux because it’s not sustainable, not self-directed. It’s faux because it exonerates the oppressive social structures that come from every direction and conspire with each other — patriarchy, white supremacy, toxic capitalism. It’s faux because it places the burden on the individual instead of calling for systems reform. This of course all comes back to race, class and privilege. Right now I’m reading Isabel Wilkerson’s masterpiece Caste, and as I think about access to self-care, real or faux, caste needs to be part of the conversation. The capacity to have the time and space to reflect, to think, to feel is a luxury that many women (and people) in America are not afforded. My book is one roadmap for finding your way there. 

In your practice, how have you seen frustrations with self-care manifest? What makes so many of us resistant to the difficult, sustained work of care? (I’m thinking here about the very capitalist and American resistance to investing in long-term gains, but you could take this in so many directions)

Real self-care is about your relationship with yourself and your relationship with your community. But in America, we have this very individualistic and commodified version of self-care right now that is completely aligned with consumerism and the idea that only something outside of you can give you what you need or want. 

And right now, wellness provides methods, but it does not give us principles or perspective. 

For example: a woman decides to take two hours off to get a massage. It costs $200, and she feels like she wasted the entire experience worrying about her to-do list. What’s worse, because she took the time ‘off,’ she felt like she spent the rest of the day catching up.

That woman is employing a method — but hasn’t applied principles or perspective to the problem. I think this scenario gets to the heart of your question and why what I am proposing in the book is subversive. Why don’t we closely at our principles? Why don’t we ask ourselves the hard questions like: What am I trying to control with my addiction to productivity? Why do I believe that more is better? Why am I trying to optimize my “rest”?

Americans are terrible at feeling their feelings. We live in a cognitively oriented society. We are outcomes and productivity obsessed. We want control and to be able to predict what is going to happen, so we need to be able to measure. All of these demands link back to capitalism and, I’d also argue, White supremacy and the legacy of slavery. Because the value is put on human production, and to gain more value, one needs more people under them to produce. It’s a pyramid scheme, for sure. Tricia Hersey, from the Nap Ministry is brilliant, and her book Rest is Resistance is a must read on this topic. 

Care work — whether it’s self-care, community care, parenting, caring for elders — it’s all investing in the future, and investing in something wherein the outcomes are uncertain. I love the word that you used, sustained, because that gets to the meat of why we devalue it: it has no endpoint. It’s much harder to measure or control or account for.

A linear model of growth says that more is better. But when you’re building — whether it’s a community or a family or an identity — the healthiest way for growth to take place is slowly. When you move slowly, you can integrate each leap into your identity, feel it, make sense of it. I have an eight month old son, so I am thinking about developmental stages, and in those cognitive leaps where growth happens very quickly, a baby’s nervous system is destabilized. There needs to be the period of integration otherwise the growth is traumatic, because, inherently, change is traumatic. But a society based on production fears slowness. When I left the cult and I was in the depths of a nearly suicidal depression, my psychoanalyst mentor at the time said that my problem was that I wanted too much, too fast. Speed is really the enemy, but our culture exalts it. 

What I am trying to do as a psychiatrist and as a thinker more generally is provide some new language and new framing for how we think and talk about not only our very personal everyday problems but also the biggest social problems of our time. Because the problems are intertwined, and so are the solutions.

I know you’re going to get this question a lot, but can you talk more about the orgasmic meditation intentional community-that-was-actually-a-cult that you joined for two years?

In addition to what you actually did, I also think it’s emblematic of an oscillation between “I follow everyone else’s rules” to “I follow ONLY MY OWN RULES, because all your rules are bullshit, and will blow up my own life to prove it” that many have experienced. What have you come to understand about that period in your life? And how did that experience with “extreme wellness” equip you to recognize the futility of others’ reliance on its (marginally) less intense manifestations? 

[Content Warning for the next answer, which discusses suicide]

That whole time in my life is a reflection of my internal conflict. I was so anger (SO ANGRY) that the rules prescribed to me — get married, go to the Ivy League schools, become a doctor, be good, climb the ladder — had left me feeling empty and despondent.

This was personal, but also it was professional. I was deeply depressed about psychiatry and the traditional medical system. I talk about this a bit in the book, but when I was a psychiatry resident, a trainee in the same program died by suicide. I remember feeling hopeless: like, we spent all this time in school, and I’m at one of the best training programs in the country…but this is happening? The type of person who becomes a doctor is someone who must be deeply committed to the integrity of the job, but then the working conditions are something else entirely. The disconnect between the two sort of broke me. 

I was seeing the same disconnect with my patients, too. There was a patient suicide in the psychiatric unit where I worked, which shook my confidence in myself as a physician, and also the profession. And then there were things like the un-housed person who comes into the ER and the answer is to give them Zoloft? That’s not fixing the problem. Or: why is my patient who has two grad degrees and now is a stay-at-home mom being put on antipsychotics for bipolar disorder when maybe how she feels has something to do with her status in her marriage? There were just a lot of inconsistencies.

And to be clear, I don’t say any of this to de-legitimize therapy or medication, both of which I have taken and been in myself – still take and still in! Now, I understand that it is not that evidence-based psychiatric treatment is wrong or bad. But, at the time, I was confused and angry about why the context was so glaringly missing, and that my efforts to confront it were not taken seriously.

I was in a state of existential despair and everything sort of unraveled. I could not let go of these questions, both inside me and manifesting in the world around me. I was depressed and under-preforming in my residency program. During this time, I watched a Ted Talk about orgasmic meditation — and it seemed to offer the answer I was looking for. I went in really deep really fast, and was eager to help the group — the Rutgers Orgasm Lab — study the practice.

Once I was there, maybe in true Sun Sign Sagittarius, Aquarius Rising with a Cancer Moon fashion, I said fuck ya’ll to the medical world and basically fled. While I was with the group — which was for a little less than two years around 2012-2013 — I ended up working with groundbreaking neuroscientists who study the science of female orgasm through fMRI imaging. Today, part of my clinical practice is taking care of patients who struggle with genito-pelvic pain disorders like vulvodynia. 

But that was a very messy time in my life, and after I left the group I was clinically depressed, nearly suicidal and had to completely rebuild my life and myself. I was a privileged person who could leave and still had a family and a prestigious career to fall back on; others did not have that privilege. I also had the medical connections which meant I could access good treatment for my depression. 

Ultimately I realized that my home, my people, were the people inside the medical field. But if I was going to rebuild my medical career, I had to do it bringing my whole self to it, and do it on my own terms. I also had to grieve the failings of medicine and the failings of the “spiritual world” — and, again, come to terms with the fact that there are no easy answers. Anyone who is too confident about their own rules ultimately will end up cracking or leading you astray. The people who ask questions (of themselves, of others) and are willing to entertain doubt are often the ones with the most integrity. 

Now, a decade after all of this happened, I’m going out into the world with a book about what I’ve learned, and I’m bracing for how I will be judged for that time in my life. I have been in my own psychoanalysis since 2016 and have spent probably hundreds of hours processing my trauma, which includes facing the fact that I provided legitimacy to a cult as a physician who believed in their ideology. 

My honesty has cost me things and I will continue to do so. Earlier this month, I found out that I lost a significant media opportunity to promote the book because of my history. When I got the bad news, my sister Deepa said, “You’ve come too far to be ashamed about your past.” She’s right, and most days, I do believe that. In Real Self-Care I reference the dialectic, from Dialectal Behavior Therapy, and the concept of Both, And. I had to be honest in writing this book, in order to be myself, and to practice the concepts of what I’m advocating for in the book. And, in retrospect, I think the human search for connection and community, even in the most unlikely of places, really is one that nobody should be ashamed about. 

Going back to your original question about whose rules to follow — society’s or our own — again, the answer is also: Both, And.

Yes, the goal is to follow your own rules — but when you have so much anger, so much unprocessed internal conflict, following your own rules means breaking a lot of stuff and people you care about. Some of society’s rules do exist for good reasons, but they have been co-opted and sort of twisted by those with power. Untangling all of this is nuanced work, and urgency that you feel when you run toward a solution can be a sign that you are taking a hammer to a problem that requires a needle. But, doing that needle work is hard because it’s care-work, and care work is deeply devalued. Sometimes we find ourselves so lost that the only thing that feels possible is to break it all, and then pick up the pieces. 

For me part of the needle-work began when I left the cult and finally had decent health insurance again. I saw my analyst three times a week in Dupont Circle for years and years. And, I was able to do that because she gave me a reduced rate — because it was walking distance from my workplace and I could fit it into my clinical schedule —and also because I had good enough health insurance that I could get some of it reimbursed. This was while I had just started on the faculty at GW around 2016. It was instrumental in me processing my anger and understanding what was a reaction to my childhood, to racism, to trauma, and to determine what I actually wanted for my life from a place of agency, instead of a place of fear or destruction. 

So what does real self-care look and feel like? What makes it hard, but what makes it is so powerful? 

Real self-care is not a thing to do, or to buy. It’s a way to be. It’s in your choices and the way you make them. 

Real self-care is not a noun, it’s a verb. It’s all the internal work, for example, that you do to get yourself to the yoga class. One person’s yoga class could be performative: they’re taking selfies and pre-occupied with wearing the right leggings. Another person’s yoga class could be deeply soul-nourishing, because they did the internal work of setting boundaries, having hard conversations with their partner to make the space in their family’s schedule for yoga, and understand why the time spent in yoga is aligned with their values. 

In other words, it’s not really about the Thing — it’s about the process you take to get there. 

And, going further, real self-care is an internal decision making process that can be layered into everything you do. As opposed to thinking of it as carving out self-care for a 15 minute pocket of the day, self-care needs to be threaded through the way we make decisions and design our lives.

In the book, I lay out a roadmap for how to do this — it requires setting boundaries and dealing with guilt, talking to yourself with compassion, identifying your values, and remembering your power. My promise is not that you will come out a new person. It’s that you’ll come out having the psychological skills to begin a new conversation with yourself.  

It's hard, because the idea of making time for all of this feels laughable, I know. I know! But that’s precisely why it’s so important. When you make choices differently, as one individual, you impact the systems that surround you — whether that’s your family system, your school, or your work-place. The debate about whether change has to first happen externally or internally is the wrong conversation. Both always happen together. To transform our outside world, a critical mass of us must transform our internal worlds.  I don’t know of any leader — and by leader, I mean at the family level, workplace level, or social level — who came to that position without going through a powerful internal shift first. Internal versus external is a false dichotomy in my mind. 

I see the cascade effect from internal to external happen with my patients. And especially in this time of collective action towards change, whether that is for reproductive justice, or paid leave, or climate justice, the first step is real self-care. Otherwise, you are still beholden to our toxic systems. 

I’d love to hear more about how writing itself has become part of your larger practice and the way you feel you can care for and help others — but I also want to know how it serves as a form of self-care for you. 

I learned early on in my journey that seeing too many patients lead me to burnout, and also that practicing only medication management lead me to burnout. So writing — whether it’s for the New York Times, on social media, for Therapy Takeway, or writing my book — is activism.

When I am not embodying those core values, I feel stuck. But I picked a career as a psychiatrist, where you are supposed to be a blank slate if you are going by Freudian principles. I sort of muzzled myself. Writing was how I found my way back — not because psychiatry wasn’t for me, but because there was an important value of mine that was not being met. 

I usually start interviews with this question, but I feel like it’s a good way to end today’s conversation. How did you get to the place where you are today, doing what you do and thinking about what you think about?

Do we have all day! Ha. In truth, this is the entire premise of Real Self-Care — I would not be here, doing what I’m doing, having the space to think and write (or, to write and to think) and build, without real self-care in my life. But, without sounding like the asshole who answers a question by saying READ MY BOOK!, I think I can distill it to two themes:

First, I had to become okay with not knowing. There were some pretty sharp inflection points for me from the age of about 25 to, now, 39. At each of those points — whether it was the end of a relationships, a career, or, even a belief system — the thing that got me to where I am is that I was okay with not knowing where the next thing was going to go.

I think there are fundamentally two types of ways a person can respond to a less the ideal situation, whether in a relationship, a job, etc. Some of us are by nature people who stay, and some of us are by nature people who leave. Melanie Beattie (Codependent No More) talks about this in her work. For better or worse, I’m someone who leaves. I left my first marriage (in a traumatic way), I left my first residency training program (also in a traumatic way), I left the cult, I left my full-time academic position (by this time, through my own psychoanalysis, my ability to leave had become healthier). 

I had to do all of that searching to find the relationships and professional worlds that allowed me the space to be all the things I need and want to be. I’m not saying I have it all figured out, even now with writing and entrepreneurship, and some days I am like, nope, this is all terrible, get me out of here!

My high tolerance for uncertainty and novelty seeking tendencies have led me to some fulfilling places, and I do credit it with allowing me to build the personal life and career that I have today. When I made my professional Instagram account in 2018, I had no idea where it would lead. At that point I had started writing for the popular press (my 2018 article for Doximity, “We Don’t Need Self-Care; We Need Boundaries” was what put my writing on the map). But I really had no plan with Instagram, I was really just playing and experimenting. Ultimately, though, it led to regularly writing for the Times, getting a book deal, founding a company, and many new friendships and professional collaborations. None of that would have happened if I wasn’t open to not knowing.

There is also a counter-point to this, in that if you are someone whose natural inclination leans more towards wandering and searching, you have to remember that a new relationship or a new job or a new city probably won’t save you….your internal conflicts will still be there, just in new settings or applications of them. Ultimately, whether you are someone who stays or leaves, you have to find the answers and meaning inside yourself. That is the real self-care message. It’s about understanding what internal needs you are trying to get met by the thing. 

The second part of getting where I am today was finding/leveraging the right sponsors, support, and privilege. As I’m talking about my book, I’m really trying to highlight all the invisible stuff that got me to where I am. I’m a little self-conscious that this will come off as virtue signaling, but I’m going to do it anyway. I could only leave my psychiatry residency position because I did not have student loans — thanks to my immigrant parents who sacrificed immensely so the next generation could have the privilege to take risks with their time. It was easier for me to leave the cult and build myself back up into a person because I had a stable family that let me crash in my childhood bedroom…and because I had a medical career to come back to. I took a pay cut for about 1.5 years as I was building my private practice in perinatal psychiatry, and, really, doing Instagram practically full time — and I could do that because I had a stable partner with health insurance and, if my practice completely failed, I had a safety net.

It all sounds cliché, but the ability to take risks, in itself, is a privilege. I wish that the self-help field would do a better job of acknowledging as much. This is also why sponsorship and finding allies is so important. There are many women from my clinical/academic world — and also in the literary and media world — who have made space for me, supported me, and given me a chance. You not only have to find those people — they also have to be willing to invest in you. And, then, it’s crucial to also be someone who pulls your people along with you while you are growing. The way you build is just as important as where you end up.

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You can find Dr. Pooja Lakshmin on Instagram here, and find her website here. You can learn more about her joint newsletter centering women’s mental health here, and pre-order Real Self-Care here.

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