Self-Care Is a Verb, Not a Noun
“I wrote this book not only from the perspective of a psychiatrist, but also someone who went deep down the rabbit hole of wellness. And I learned that wellness has as many hypocrisies as medicine.”
In 2008, disillusioned by the medical system, Dr. Lakshmin left her residency to join an extreme wellness commune that turned out to be a cult. She was seeking something outside of mainstream medicine that could help with the anguish she was feeling. She yearned for community, and for something outside of the hierarchical structure of medicine. But what she found was that the wellness industry is just as flawed.
In this episode, we dive into the world of self-care with Dr. Pooja Lakshmin, a board-certified psychiatrist and author of the book, "Real Self-Care: A Practical Guide to Feelings and Change." Dr. Lakshmin joins us to discuss the contradictions of the wellness industry and the paradigm shift required to practice real self-care that can empower and uplift women, and maybe even start a revolution.
Dr. Lakshmin believes that the cultural embrace of self-care is incomplete and manipulative. In her book, she helps readers understand what a real practice of caring for oneself looks like, and provides a step-by-step program for real and sustainable change and solace. Using case studies from her practice and clinical research, Dr. Lakshmin shares actionable strategies to deal with common problems, set boundaries, move past guilt, and assert power.
In this conversation, we delve into the misconceptions around self-care, the impact of oppressive social systems, and the internal self-reflective process required for real self-care. We also discuss the importance of making difficult decisions in line with our values, and the power of self-compassion in our lives. Tune in to this episode to learn how to shift your relationships, workplaces, and even broken systems by practicing real self-care.
Topics covered:
How she “blew up” her life at 28, dropping out of residency, getting a divorce, and joining an orgasmic meditation commune
Being disillusioned by the medical system… and then by the wellness industry too
Why psychiatrists have some of the highest rates of suicide of any profession, and what we can do about it
The misalignment of the RVU productivity model in medicine
Tips for healthcare workers who are burnt out
Why self-care is a verb not a noun
What is real self-care, and some simple exercises to find your values and priorities
About Dr. Pooja Lakshmin
Dr. Pooja Lakshmin, MD is a board-certified psychiatrist , a New York Times contributor, the founder of Gemma, and author of the new book Real Self-Care: A Transformative Program for Redefining Wellness.
She is a clinical assistant professor of psychiatry at the George Washington University School of Medicine, where she is a clinical supervisor in the Five Trimesters perinatal psychiatry clinic. Dr. Lakshmin is most passionate about empowering women and sees her clinical work as a perinatal psychiatrist as an extension of this mission. She maintains a private practice where she applies an integrative approach to taking care of women suffering from maternal mental health conditions.
She also serves on the board of directors of the Maternal Mental Health Leadership Alliance, a national non-profit dedicated to furthering maternal mental health policy, and is active in advocacy work and community building through online platforms, including her Instagram page. Dr. Lakshmin is a frequent contributor to The New York Times, and her advice has been featured on The Drew Barrymore Show, NPR, Glamour, Marie Claire, Self, Harper’s Bazaar, Bustle, and various other media outlets. Her first book discusses the tyranny of self-care and offers a novel framework for women to build authentic and sustainable well-being in the face of systemic stressors.
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Transcript
Halle: This is the Heart of Healthcare Podcast and I'm your host, Halle Tecco. May is Mental Health Awareness Month and Women's Health Month, and I have a special guest today. Whose work is at the intersection of the two? Dr. Puja Lak is a board certified psychiatrist focusing on women's health. A New York Times contributor, a founder of Gemma and the author of the new book, real Self-Care, A transformative program for Redefining Wellness.
Puja, thank you for being here today. I wanna start by having you walk us through your own journey and what brought you to where you are today. And I especially wanna hear about blowing up your life at 28 when you dropped out of residency and joined a commune slash cult.
Pooja: Yes, yes. Let's just dive right into it and just get it all out into the open. So I'm a psychiatrist. I specialize in women's mental health, and I am 39 now. Um, I live in Austin, Texas, but about a decade ago, like you said, I blew up my life and I went. Very deep into extreme wellness. And that's part of the reason why I wrote this book, real Self-Care, because I have been there.
You know, the sub subtitle of the book is Crystals, cleanses and Bubble Baths Not Included. Um, and uh, so I'm writing it not only from the perspective of a psychiatrist, but also as someone who went very deep down the rabbit hole. So, You know, this was around 2012, I think. So, you know, more than a decade ago at this point, I was in my late twenties.
Um, and up until that point, I had followed all the rules. I had done all the things that I was supposed to as a good South Asian girl. You know, my father's a physician. My parents are immigrants from India. You know, I went to an Ivy League college. I went to Penn, shout out to Penn. Folks that are listening, went to medical school, became a doctor.
Um, I went to Jeff for med school, um, matched at my top choice residency. I got married. Um, and so it was like I checked all the boxes off the, off the list, right? And, and so. For the first time in my late twenties, I was like, okay, well let me figure out how to be happy. I've done everything that I'm supposed to.
Now how do I be happy? And of course, like that didn't work because I had constructed my life based on everyone else's values. Not my own. And, and I didn't even really know what my own values were, to be honest. And then on top of that, I was training to become a psychiatrist. I was in my second year of my residency.
And for folks who are familiar with psychiatry residency training, the PGY two year is a particularly tough year in that you're working on inpatient units, you're, you're working with the folks who are the most vulnerable and, and often the most under-resourced as well. And I was, Really, really disillusioned with medicine and, and the medical system.
You know, I, I was, I was questioning everything, you know, it was like things that, that are, we now know in 2023 that the medical establishment is deeply broken. But, you know, more than a decade ago, this wasn't part of any common conversations. So even things like, you know, a patient comes in and they're unhoused and they need, what they need is housing, but all I could do is.
Write prescriptions for medication or you know, another patient who is losing her job because she's lost childcare for the fourth time in a month. And again, I can do psychotherapy with her. I can write her a prescription for Zoloft, but I can't change the fact that she's lost her job. And I, and I can't do anything about employment laws in America.
So I was feeling really angry and let down. By, I, I went into medical school, very naive. I thought that by becoming a doctor, I would have all the tools that I needed to help people. And it was, and when I found out that, that that wasn't actually true, that there were lots of things broken in the world, in our society, in our culture, that doctors don't have the power to fix.
I. Was, it threw me into a tailspin basically. And so I, I left, I blew up my marriage. I moved into a commune in San Francisco that was focused on female orgasm and meditation and spirituality. I dropped out of my residency and I spent two years with this group, and in a lot of ways it was very transformative for me.
I got to work at. A neuroscience lab at Rutgers that focused on, um, the neuroscience of orgasm and putting people in FMRI machines looking at the brain during female orgasm, which was very cool. But by the end of that period of time, I came to understand that the wellness world, the quote unquote spiritual world, has just as many hypocrisies and contradictions as mainstream medicine, and that you can't.
You can't run away from your problems and that real self-care actually has to happen in your own life. And so that's one of the reasons why I wrote, I wrote the book and um, it's a big part of why I'm here right now with doing the work that I am with Gemma and on social media and, um, with my writing.
Halle: So it's almost like you had, you checked off all the boxes. But then realized that you were checking them . Off of the wrong list. It was someone else's list. It was like, you know, I did all the things that I'm supposed to do, but this is actually not Pooja’s list of fulfillment and happiness. It was society's list of things that they want you to do?
Pooja: Yeah, and I think it was even one step further than that in that, cuz I spent six or seven years in psychoanalysis after this period of time. And psychoanalysis is that very intense type of therapy where you're laying on the couch and the analyst is behind you and, you know, you're really sort of exploring the depths of all the things.
I, I don't know that it was the wrong list. It was, it was for the wrong reasons. Hmm. And I say it, it was, it was the list of what gives you a secure life. A privileged life, right? Being able to become a doctor in America comes with huge amounts of privilege, right? So I don't wanna blame my immigrant parents because I think they were doing it.
They were. Pushing me in that direction because they believed that it would lead to a better life for me than the one that they had, and that it would lead to more options and choices for me. And because I had that privilege, I then had the luxury of being able to essentially have an existential crisis and blow up my life and kind of start over.
And most people don't have that luxury. So there is nuance there. But what I've come to understand is that, It's not that, it's less about the rules and more about understanding your reasons behind Hmm. Them. Yeah.
Halle: And, and what, what was it that you were looking for at the time, and did you find it during those two years?
Pooja: I was looking for quite a few things. I was looking for understanding and meaning. I wanted to understand myself better. I wanted to understand why I was so deeply unhappy in the life that I'd built for myself. I also was quite angry and frustrated with psychiatry and with medicine, and so I wanted to learn for myself.
Whether there was another solution, another answer. And in, in the beginning, I felt that there was right that, that there was something outside of mainstream medicine that could help with the anguish that I was feeling. I think I was also looking for community and safety. I was looking to be sort of outside of the hierarchical structure that medicine is built around, and the context there is that I'm somebody who, I went straight from undergrad to medical school to residency. I didn't take any time off and, and partly that was, you know, I. There's a lot of reasons for that, but I, partly it was that I, I, it was sort of like this internal drive and desire to feel like I was sort of cons.
I was achieving those outward manifestations of success. So being with this group felt like it was a place where I didn't have to keep striving. Mm-hmm. And I hadn't had that before really. In that, in that way.
Halle: And you said that you were disillusioned by the medical system. I'm curious if you ultimately overcame that or if you're still disillusioned.
Pooja: I'm absolutely still disillusioned. I'm still disillusioned and so, but when I came back to medicine, I came back a different person. I came back holding onto myself and understanding that. Medicine is flawed, just like human beings are flawed, right? Just like the wellness and spiritual world is flawed too, that whenever you're interacting with a system that lives inside of capitalism, that is influenced by things like racism and white supremacy and patriarchy and sexism.
There will always be pieces that don't fit you and that are harmful. And so my job coming back to medicine, coming back to residency and deciding to give it another go was to hold onto myself. And that's the work of real self-care. So for me, and we can dive more into it, I made many different decisions when I came back to medicine that were aligned with my mental health. So part of that was starting a private practice. Um, so I'm on the clinical faculty at George Washington University, but I make my income from my small private practice. It also evolved making the decision to do psychotherapy with my patients. I found that when I was only doing 30 minute medication management visits, that burned me out.
I really enjoy doing therapy. I love being a therapist. Part of what is fulfilling for me as a psychiatrist is getting to work closely with my patients. I also came to understand that seeing patients five days a week, uh, was not good for my mental health. And so now I see patients two days a week.
And the rest of my time I run Gemma and I write and do other creative things. I wanna caveat this by saying that. The big piece of my work is being transparent about social determinants of health, and so one of the reasons that I'm able to have this flexibility is because I have a partner who has a stable employed job.
I have my health insurance through him, right? It, there's risks involved in making these decisions, but that's how I have made a career in medicine work for me. I've, I've really prioritized my mental health and I've understood that one of my core values is autonomy. Um, I like to be able to work for myself and, and I am happier when I am I'm my own boss versus working inside a system.
Halle: Yeah, same for me. So, you know, we do a lot of dissecting the different problems within the healthcare system on this podcast. So a question that I like to ask is that if you could wave a magic wand and fix anything in our system, what would that magic wand do?
Pooja: Hmm. Gosh, I, it's hard for me to answer these questions in the sense that I'm not a public health expert. I'm not a policy expert, so I don't know all of the technicalities of the right solution, but maybe what I'll say is cuz there's so, so much wrong, right? Like there's just so much, so much is broken from the top and from the bottom. And so from a patient perspective, you can't find a therapist who takes, or a psychiatrist that takes insurance. Mm-hmm. If you live in a high cost of living area. Right? Yeah. Nobody takes insurance. You know, when you call your insurance company to find people who are in network, all of those people are not taking patients. If you are lucky enough and, and I fall into this category, my insurance reimburses me. I get 70% back when I see my psychiatrist and my therapist. But you have to do all this legwork to submit those super bills. Yeah. And fight with your insurance company to actually get that money back.
There so much bureaucracy and then, you know, at even another level with kind of like actually getting your medication and having prescriptions covered. So there's so much that could be changed. I think from a women's mental health standpoint though, because I'm a perinatal psychiatrist and all of my patients are women, most of my patients are pregnant and postpartum, so dealing with perinatal mood and anxiety disorders.
One of the places I'd love to wave a magic wand is in actual research funding. Like I would love to see randomized control trials that are actually looking at all of the psychiatric medications in pregnancy. So we have a lot of data on SSRIs, but like, let's see, more work around stimulants. More work around like the newer mood stabilizers. More work around benzodiazepines like. We know a lot of those medications are actually quite low risk and, and in my field we're doing, there's a lot of work around kind of educating. Medical students and residents about the fact that it actually is more, can often be more harmful to take a pregnant woman off of her psych meds than to continue them, right?
Mm-hmm. And kind of really getting that word out there. But I would love to see more well done research and science looking at the broad spectrum of psychiatric medications during pregnancy and breastfeeding so that we no longer have to say to our patients like, we don't know.
Halle: Great one. All right, well anyone listening, reach out if you can help with this. So I wanna talk about being a psychiatrist and the toll that it takes on the specific group of providers.
I read a study showing that psychiatrists have some of the highest rates of suicide of any profession. What's happening here? And is there anything we can do to fix this?
Pooja: It's interesting because for a period of time people viewed psychiatry as sort of a cushy specialty in medicine.
You know, we've always been sort of the black sheep of medicine, not real doctors, right? We're psychiatrists. But I think more and more people are understanding the load of, of what we deal with and that. It can be really emotionally taxing and certainly in the pandemic at the height of the pandemic. I think what was different in psychiatry was the fact that many of us as clinicians were living through.
The same circumstances that our patients were living through. Right? So you couldn't really, like, it was almost like a little bit of a boundary was crossed because we were all at home, we were all dealing with the stresses of, you know, whether it was like childcare or you know, all the different things that were going on.
There was a way where the veil was sort of pierced a little bit. I think that. Is ultimately a good thing because it humanizes the profession, but it also makes it tough because when you're also. In a, when you're overextended in terms of your emotional resources, it becomes more difficult to bear the weight of your patients suffering as well, right?
Yeah. When I was speaking a little bit earlier of like for me, my real self-care as a physician and as a psychiatrist was. Getting really honest with myself about how much patient care I could do. Right? And this was pre pandemic, but um, I think during the pandemic it came into, View for more folks who work in mental health, like understanding that I can't just push myself to the limit, right?
Like there's a consequence to that and I have to know what my boundaries are. I have to know what a reasonable patient load is. I need to pay attention to how I feel, right? And how I feel is important to the decisions that I make about my career. And I'll say to that, there's a lot of guilt that goes with that.
Um, in the mental health profession because we know how long the waiting lists are. You know, we know how hard it is to find help. Yeah. Um, and if you go into this work, you do it because you do, ultimately, you are driven by wanting to help people, right? So there is this difficult decision making that you have to come to peace with on your own, that your own mental health matters.
That it's not. That if you don't take care of yourself and you don't have boundaries for yourself, then, then you will burn out and then you will end up leaving. Right. And that's not helpful to patients either. You know, one of the questions that you asked was around what is the solution? Yeah. And I think, I don't know how to achieve this.
I can't answer that. But I do know, like from a solution standpoint, like what, what psychiatrists and mental health providers need is, is we need more agency, right? We need more, we need. We were talking about earlier, if you were just seeing, like, if you're seeing like 30 patients a day and doing like 15 minute med checks, like that's terrible.
Like Yeah, I, I, and I know a lot of community, community psychiatrists that that's their week. Right. And I, I can't, I can't work like that. That's just, it's not. My mental health is, is really impacted then, and so we need workplaces and, and structures that support the autonomy and the time of. Mental health treatment.
And the thing is that mental health treatment is actually care work. It's care labor, right. It's time intensive. You need that 50 minute session, you need that whole session. Right. And, um, when we're in an RVU productivity based model, there's a huge values misalignment there. Mm-hmm. Because in those types of systems, the.
Impetus is to squeeze more and more productivity out of the psychiatrist. Yeah. I'll say one more thing on this. Yeah. Is that, um, I think teams are really important as a resident. I worked at core service agencies and when I was working on a team that was truly, uh, multidisciplinary, And that was truly respectful of all of the different perspectives that people were bringing, whether it was the physician, the social worker, the case manager, the occupational therapist, that teamwork, that's what Bo Boy owes you.
You know, you. It buffers the stress as well. Um, so if you're inside a system where there is a real team and that team, everybody's pulling equal weight, that, um, that's really powerful too. The problem is that in a lot of these work environments, the physician or the psychiatrist is sort of put. In a corner and said like, okay, well you're just a quote unquote prescriber.
So you just see patients every 15 minutes and like, write your prescriptions and like, here, oh, you get a 30 minute lunch break. But other than that, like, just write your prescriptions, do your notes, and that's it. And that's just such a, that's a crappy place to be.
Halle: You know, one question I have just following up on. I imagine a psychiatrist or therapist of any form having hours and hours of really heavy conversations that you have to be on for, you know, you probably end the day just with a heavy load, just like a sense of a dark cloud over you almost.
Cuz it's, it is, it is taking everyone's traumas and processing and helping them process. Do mental health professionals get the mental health support they need? Do psychiatrists have their own psychiatrist to support them in supporting others?
Pooja: Yeah. Um, good question.
Very important question. Yeah. Yes, they should. Uh, and I do, I have a therapist, um, and I have a psychiatrist, so, Yes, we should be. And, and I think we need to normalize that in psychiatry as a pro profession. It's one of the reasons that I started my social media account as well, is to kind of be, to humanize the profession.
So, so yes, absolutely that people who work in mental health absolutely should and, and often do have their own therapy support. And I think we should be talking about that more. To the first point or your first question of like, is it really heavy? It's actually funny because I find doing therapy with my patients to be much more energizing, even if it is a really hard session, even when there is grief and heaviness.
Because in that 50 minute session, the whole goal is that I'm there with my patient. I'm, I'm helping them reframe how they think about it, like we're coming to. We're not coming to a solution every session, but we're coming to a shared understanding and, and it feels like there's movement, right? Like, yes, it could be really sad and hard, but when there's movement, that energizes me.
And, and I wouldn't have gone into psychiatry if that wasn't the case. I know that this, it's, this is not, not everybody's personality is like this, but that's energizing for me. I actually am less energized by, Um, just like writing a prescription for somebody who is generally fine and stable and there's like, not really anything to like Yeah.
Sort of like work through, you know? Mm-hmm. Um, so, so it's less about the stuff being heavy and hard and it's more about do I get to use my time with that person in a way that. Feels useful for them. And then in turn I'm able to internalize that and and feel like I'm in alignment with my values and with what I enjoyed, how I enjoy spending my time.
And again, like that comes back to agency, right? And I think that's why it's so hard for many physicians, psychiatrists, mental health professionals, when you're employed by a big system and you don't have that flexibility, your agency.
Halle: Over the years we've been promised that self-care bubble, bath spa days, face mask, jade eggs would solve all of our problems. But I think now we're all looking around. And realizing that we're just as stressed and burnt out as ever before, but with less money because we spent it all on self-care. Uh, you coined the term faux self-care to describe these very temporary relief valves that have been ineffective at best and harmful at worst.
When did you identify this disconnect and how did you kind of have this, or when did you have this like aha moment that this was something that needed to be corrected?
Pooja: Yeah, so, you know, I've been thinking about it probably for the past decade, like since my own personal experience, um, with Extreme Wellness.
But it was in, around, I think it was 2018, I wrote a piece for Doximity, which is a physician website and went, it went sort of viral. It was called We don't need self-care, we need Boundaries. And it was all about how in medical culture we're sold, sort of these resilience workshops and. Mindfulness and all these different things when in fact, what women physicians needed to do was to learn how to say no and set boundaries and to set limits with these Yeah.
Systems that were just extracting productivity for us and, and Right. Like wellness wasn't gonna solve that. Yeah. And that evolved to me writing for the New York Times and then led to, um, Writing this book proposal. So it's been, it's been here with me, but I think it's taken different forms, especially in the past like five or six years, when I've seen more and more patients come in and say things like, you know, Dr.
Lman, I'm stressed out, I'm burnt out, I'm not eating well, and I'm not sleeping well. But I feel like it's my fault because I do have a meditation app on my phone that I know I'm supposed to be using. Yeah. And I do have, you know, I know I should go to yoga. Right. But I can't find the time and, and that's when I came to understand like, time is a social justice issue and these.
Solutions, whether it's the yoga class, whether it's the bubble bath, whether it's the meditation app, they're a Band-Aid, and it's not, I'm not trying to demonize the Band-Aid before anybody like ats me about their yoga, right? It's not that that's bad, but it's a band-aid. One of the metaphors that I like to use about the difference between faux self-care, Versus real self-care is that imagine you're drowning and somebody throws you a life raft.
Right. You need that life raft. Mm-hmm. And that's the faux self-care. Right. You need that. You need something to, to hang onto when you're drowning. The real self-care is what is your plan to swim to shore? Mm-hmm. Like how do you get back to shore? Yeah. Right? And that's something that only you know what that is, and you have to figure out what that map is.
That's the internal invisible work. Yeah. And everyone's. Path back to shore, it's going to look different.
Halle: I've heard you say that real self-care is a verb, not a noun. And that's exactly what you mean. It's the verb, it's swimming to shore. It's not the noun of the life raft.
Pooja: Right. And the the life raft comes from the outside, right?
Mm-hmm. It's something that's prescribed from the outside, whether it's an activity, whether it's a task, right. And it gives you that little bit of relief. And sometimes it's an escape, right? And we need that. That's not bad. But you can't ex. Expect that escape to fix your whole life. Yeah.
Halle: Would you say it's necessary but not sufficient?
Pooja: Yes, I think that's right. Yeah. Yeah, yeah, yeah. So what is the self-care compass that you talk about? So there's four principles to real self-care. The first is setting boundaries and learning how to deal with guilt, and that's number one, because you first have to figure out how to reclaim your space and your time.
So that's where boundaries fit in. Principle two is self-compassion, learning how to talk to yourself with kindness and with respect. The third principle is where we get to the real self-care compass. So principle three is about. Identifying your values. And then here's the really hard part, actually making choices that are aligned with your values.
And I'll come back to describing it, but just quickly to round it out. The fourth principle is understanding that this is power. This is how we get power back from these oppressive systems. Whether the system is healthcare system, right, or whether it's the medical system, whatever it is, when the solution, when real self-care is personal and not commercial.
Then we have a fighting chance of getting to collective action and collective change. So the Real Self-Care compass is a tool that I created to help. Give you a visual map of your what, your why and your how, or essentially sort of looking at your goals, looking at your values, and getting clear on why you're designing your life in the way that you're designing it.
So the crux of this is, In really knowing your values. And if we kind of think back to what the beginning of our conversation during my midlife, uh, existential crisis of where I kind of came to find out where I don't know what my values are. Like I don't actually know what's important to me cuz I had taken someone else's.
The, it's actually really hard work to figure out what you value, and especially for busy healthcare providers who are spending all their time taking care of everybody else. What I find in my practice, when I ask people like, what are your values? My patients usually get really mad at me. Like they're just kinda like, Puja, I don't have time to think about that.
Like, how dare you? Like do you see my to-do list? Yeah. Um. Or you get like a canned sort of stock answer back. Like people are like, oh, well, like I value my family. And it's like, well, yeah, that's great. Like we all value our family. Like that's, that's not helpful. Like how do you value your family? Why do you value your family?
Like a value needs to be a verb or an ad verb. It's not a noun. Hmm. Um, and so, In real self-care, the way that I come to it is indirectly, right? Because when you, when you ask that question directly, you don't get the real answer. So you have to kind of come to it indirectly. So one of the exercises in the values section is, it sounds really silly, but again, like it works better if you're, you kind of make it fun and silly.
So imagine that you have $200 to throw yourself a dinner party. What would that dinner party look like and. When you hear that example or that thought exercise, the first thing you kind of immediately grasp is that every single person on the planet will have a completely different $200 dinner party, and there is no one right or best dinner party.
It really is up to you like, what do you actually like? Are you somebody who loves music and are you going to have everybody asked, like send an um, Like curate a Spotify playlist, right? Or are you really into travel and are you gonna have everyone bring a dish from a different continent, right? Like there's just so many ways that this could play out.
So giving yourself like a little bit of time to sort of play around with that thought exercise. And then once you have it in your mind, pulling out like, okay, what are the values words that come out? From that example, for one person, it might be like silliness and humor. Like, I wanna look around that room and make sure everybody's laughing.
And so if silliness or humor is something that you value, then what you do like the work, the hard work to be clear is then like looking through your week or your day or your month and like, when am I embodying silliness and humor? How does that show up in my life? Can I bring that into my parenting more?
Can I bring that into my work? If I work in a, in a environment that is very serious and high stress, do I need to find ways to have more free time so that I can go to a comedy club or like, you know, whatever, like, you know, it's like there's a difference. Watch SNL for everybody, right? Watch snl. Yeah. Or like maybe one of your values words that comes out or another person is sort of like, Connection, right?
Like really wanting to feel like you're getting to have one-on-one conversations with everybody who comes to this dinner party. And so in that case, how do you thread that through your work life? For example, if you're usually on Zoom calls in big groups, maybe you wanna make it a priority to do one-on-ones with folks once a week to get to know people a little bit more on a personal level.
So again, like with real self-care, it's not. Like, yes, we need those life rafts, right? We need the bubble baths. We need like those little timeouts, but the Swim to Shore right, is really about your values and how you're constructing your life and, and the really big choices around like, you know, what is my career?
How, how do I, how do I, um, Do I wanna have kids? Am I a parent? If I am a parent, how do I parent who's my life partner? Do I wanna have a life partner? Like all of these different things. Mm-hmm. Like real self-care is something that's threaded through all these big decisions in your life. Mm-hmm.
Halle: And do you think that's a good exercise for folks at most of our listeners who, especially those that work in healthcare are facing burnout right now?
Do you feel like doing this exercise and creating your own compass can help you? Feel more energized and better at just showing up every day.
Pooja: So I would actually say for those folks, I would recommend first working on boundaries. So in real self-care, I actually have a quiz. It's called the real self-care thermometer.
And you can take the quiz to get a better understanding of where you fall on the spectrum. If you're a healthcare worker, you're probably gonna be at red on the quiz, which is like for sure close to burnout, right? So step one, the values is sort of advanced in that category. So the first thing actually is boundaries.
And my conceptualization of boundaries is a little bit different. So in 2016, when I first started on the faculty at George Washington University, My mentor took me out for lunch and she gave me one piece of advice. She said, Puja, you don't need to answer your phone. You can just let it go to voicemail.
And then you can decide what to do. And that was an aha moment for me because I realized like, oh, like your boundary is in the pause. Like the pause is the boundary. And sometimes it's the front desk, right? And I can say like, Hey, like I'll come at the end of the day and sign the paperwork that you need.
Sometimes it's a patient who, like a patient who I know if she misses a day of her stimulants, she's gonna be in trouble. So like, I'm gonna put that refill in right away. Right? But it's. The pause, it's that space where I decide, and then I can say, yes, I can say no or I can negotiate. So I would say for healthcare providers that are listening, that might be close to burnout or, or definitely burnt out.
The pause, the boundary is the place that you start. And then once you're starting to. Like, help train your brain and get comfortable with that pause, cuz you will feel selfish for sure. It's gonna be, you know, it's, it's a work in progress. Then after that, then you come to self-compassion and then you start to look at values.
Mm-hmm. Really, like that was the other thing that was important to me in writing real self-care, is that I. I, I'm not overselling anything here. Like this is, this is a long process, right? Yeah. Like this is not something that you just like read this book and then you're like, oh my gosh, my, the birds are chirping and like, everything's great.
No. Like this is the type of thing where it's gonna take weeks, months, years, and that's okay. Because you know what f what I learned from my own personal experience is that when you're in that dark hole, when you're burnt out, the illusion is that there's gonna be one magic, right. Answer that's gonna fix everything.
And the truth is that there's gonna be's not easy. No, it's not that easy. There's actually thousands of right answers. There's thousands of small choices. Your job is not to know every single answer. Right now, your job is to just follow that small path, right? And it starts with boundaries. Right. And then you just keep following that thread and it's, it's still a process for me.
Like I'm in a new loop now of writing a book for the first time and being on a book tour and talking about it and trying to balance Gemma and my patients and being a mom. Right. And so this is another loop for me of real self care. It's not something that you just like know it and learn it, and then you're done.
It's, it's something that you're just constantly navigating.
Halle: Yeah. Yeah. I don't know how many times my reply to emails is like, I'm just over capacity right now. Reach back out in March and I don't know what I think is gonna be different in March. Right. But just like putting it off makes me feel better.
But it, like, it actually never, it, it never lightens up. So I feel like I need to kind of re rethink about how, um, I set those boundaries with some of just the, the inbound I get from, from people. So you mentioned your startup. So in addition to practicing medicine and your new book, you have this startup, Gemma. Can you tell us about it?
Pooja: Yeah. Yeah. So Gemma is the women's mental health, uh, masterclass focused on impact and equity. So I found a Gemma in 2020, and it was really born out of my Instagram account to be transparent, you know, I was on Instagram and, and there really weren't, Many psychiatrists and definitely not perinatal psychiatrists on Instagram at that time.
And I wanted to be able to provide evidence-based education and have it not have to be on social media. And so I started doing Zoom classes about pregnancy, postpartum, and mental health. Um, and a couple months after that I started talking to my co-founder, Dr. Callie Cyrus, who's a black queer shrink about coming on board.
And then we got connected with Dr. Lucy Huttner, who's a repro psychiatrist in New York. And, uh, we have kind of a whole slew of different offerings. So we have Zoom classes that are focused on different aspects of women's mental health. We have courses for healthcare providers. We have one that's coming up on pregnancy and stress.
And then we have these WhatsApp threads as part of our membership. Um, and I'm gonna be doing real self-care for healthcare workers, um, in 2024. So we're kind of in this space right now where we're navigating a whole bunch of different, different offerings. All under the same umbrella of. Women's mental health across the lifespan and an education focus.
So we do not provide clinical services, and this is by design because all three of us really feel like our strength is in the education that we do. And all three of us see patients in our own practices. Um, and there's, there, we're kind of looking at this as like a third space. You know, there's therapy, there's medication, there's places to get those things, but there's not.
A facilitated space for real, in-depth conversation. Mm. And so that's what we're doing on the WhatsApp threads. We, we launched a subs stack recently that's called Therapy Takeaway, and we have about 7,000 subscribers, so, so yeah, it's kind of an exciting time. Yeah. I will say one of the things that I've learned in the entrepreneurship process is that being a founder, Is like being a founder, writing a book and being a mom are all like, just wildly all consuming experiences.
Consuming, seeing wildly intense, and also like the same sort of like, Just like birth space, right? Mm-hmm. Where you just don't have a lot of control, right? Yeah. And you're kind of, um, exploring lots of possibilities and sort of like moving with a lot of different things. And, but part of my real self-care is understanding that I'm, I'm drawn to those types of roles.
Yeah. So, so then it's like, What we were talking about before. Okay. If you know that this is something that's valued, aligned for you, how do you do it? And also build in buffers for yourself. Yeah. Right. If you're in it for the long haul, then you have to kind of craft it so it's sustainable. So I'll say one real self-care decision for me as well.
June and July, I'm gonna be taking Fridays off. Oh, nice. Um, yeah. And that's four weeks, that's, that's actually, yeah. 40 weeks. That's helped me a lot of knowing that's coming. Yep. And knowing I've made that commitment for myself and, and also knowing that that's just right. It's a little season, June and July, that's what I'm doing.
And, and so it's like, it's also like time limited. I, I have too much anxiety to always take Fridays off. Right. But, but I can, maybe it's in a few weeks. Yeah. Right, right.
Halle: Mm-hmm. Um, I do wanna say that I don't think I would advise anyone to do two of those three things. I do wanna plug that I am a Gemma customer.
It is so reasonable. $5 a month, and it's like a, and the WhatsApp group is like a, a support group. I'm really impressed by the. The rawness and the honesty that people are sharing, it really feels like, um, a safe space where you can kind of dig into these things. And there are different, different groups that you can join.
Pooja:.Well, thank you Hailey. I, I actually didn't even know that you were a member, so thank you.
Halle: I had to do some diligence for this podcast, but yeah, I'm really, um, glad that I joined and I recommend everyone kind of check out the website. It's so easy to sign up and it's really exciting what you're working on.
Um, so my last question for you is you working on this. Startup launching this book and the book tour, um, as well as your private practice. You're hopefully taking care of yourself and, um, you know, practicing what you preach. What is next for you? Is it just kind of settling into this life of doing these disparate things?
Is it, um, are there new things that you have kind of on your radar? What can you tell us about what's next?
Pooja: Yeah, so I think. Definitely part of the process for me has been transparent. Being transparent about how the book launched did impact my mental health, you know, that I was really stressed for a period of.
Like three or four weeks immediately following just because of the volume of what was incoming. Yeah. And the sheer volume of like having to make quick decisions about what to say yes to, what to say no to. In a lot of ways it reminded me of like sort of founder role too, where it's like there's these periods where things are really intense and you just have to kind of rise to the occasion, but what's the blowback of that?
Right. Um, so part of my real self care has been. Being transparent on social media about how this isn't all just like rosy, you know, centering my mental health and like how I'm talking about the book. I think for me, really what I'm thinking about is that period of rest, that June and July where I think things are gonna be calmed down.
I, I've also come to terms with the fact that now because of the book and because of the direction that my career has taken, that. I am in some sense, like there's a seasonal nature to my career in that spring is always gonna be busy and holidays time is gonna be busy. But that summertime could be a little bit more off, I think.
Yeah. And so I'm gonna try or not, I'm gonna try, I am going to be slower over the summer. Yeah. And like really use it as a period of rest. And then coming back in the fall, we have a whole bunch of Gemma programs launching and, and I think 2024 is really gonna be the year of real self care. And Gemma, and I don't have kind of like specifics yet to share, but I think I, what I've been seeing is that healthcare workers have really been resonating with the book and with the real self care message.
And yeah, and I think maybe because of my personal story, I feel a special connection to women physicians in particular, and the plight of women physicians. So I really wanna find ways to engage with women who want to go deeper into the real self-care work and, and figure out how to build that into Gemma.
So, so to be continued, but yeah. Um, exciting things and, and I'll also. Hopefully rest too. Yes. I love, even though, as I say, as I say in the book, I'm somebody who's allergic to rest, but I, I force myself. Right. Because I know we have to.
Halle: Friday afternoon, nap sounds so delightful. Well, Dr. Lakshmin, thank you so much for joining us today.
Pooja: It was such a pleasure to be here. Thank you so much for having me.