Real Self-Care, page 3
Seventy-some years ago, in the 1950s, psychiatrists used the term self-care to describe the ways in which institutionalized patients could assert independence by taking charge of their diets and engaging in exercise while in the hospital. By the 1960s, nursing and medical professionals talked about their own need for self-care in response to compassion fatigue and secondary trauma. Fast-forward to the 1970s and self-care moved from the medical community to activist circles, with the Black Panther Party promoting self-care as a means for Black Americans to preserve their humanity in the face of systemic racism. It was Black women who actualized the concept into public discourse. Audre Lorde defined self-care as a powerful act to reclaim space within a society that demanded minorities and oppressed groups stay small or invisible. As she wrote in her 1988 book, A Burst of Light, “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” [6] As we’ll discuss in Chapter 3, real self-care is built on this very notion and, when implemented authentically, has the potential to change our broken system.
By the 1990s, as the economics of health care in the US were shifting, health-care professionals began encouraging patients with chronic medical conditions like diabetes and high blood pressure to take primary responsibility for their health as opposed to being passive recipients of care.[7] Researchers found that for those living with chronic illnesses, self-care in the form of exercise, healthy diet, stress management, and other lifestyle interventions was associated with better health outcomes.[8]
Self-care as the so-called cure that we now know it as evolved when the world became more hyperconnected. As we transitioned to smartphones, a twenty-four-hour news cycle, and a plethora of ways to keep up with family, friends, and complete strangers via social media, we also saw a parallel need for a balm from that stimulation overload. Self-care was no longer relegated to the realm of health, nor was it about standing up against oppressive systems. Instead, it morphed into a release valve, designed to bring you a momentary sense that things are all right. By the 2010s, the term self-care had exploded on social media and in the daily fabric of women’s lives. The more out of control and dysfunctional our social structures became, the more our social media feeds were filled with glossy images of women seemingly living their best lives in picturesque locations. (Interestingly, Google searches for self-care peaked in November 2016, following election night in the United States.)[9]
As a psychiatrist, I’m understandably interested in the connection between the explosion of faux self-care and the status of mental health treatment. While not everyone who engages with faux self-care needs professional mental health services, the symptoms of a major depressive disorder or a clinical anxiety disorder have quite a bit of overlap with those of burnout and chronic stress. But mental health treatment (like seeing a psychotherapist or a psychiatrist) is financially costly and typically not covered by insurance, and so remains inaccessible to many. It also takes time. The work of psychotherapy is not instantaneous—it can take months to see some progress (or to even get off a waiting list to be seen!). Similarly, trying to find the right medication can also take time. On the other hand, the seemingly easy and shiny solutions of faux self-care are, well, so much more simple and sexy. Why fight with your insurance company when you can buy a vitamin pack that your favorite influencer recommends, and it will be delivered to your door the next day?
So we can’t talk about faux self-care without talking about mental health treatment. We also can’t talk about any of this without acknowledging there is a huge gap in access to affordable mental health services. There are several parts to the interplay between mental health and wellness solutions—first, a lack of education and awareness for many women about what constitutes a clinical mental health condition. Then, there’s the stigma that still exists around seeing a therapist or a psychiatrist. Finally, once you’ve crossed all of those not-insignificant hurdles, there is the lack of insurance coverage, and the fact that finding access to a good therapist and psychiatrist is still only possible for the most privileged in our society. It’s in this context, where actual treatment for mental health conditions is inaccessible for the vast majority of folks, that our culture serves us faux self-care as a quick fix and as a poor substitute for professional help. I don’t mean to shame anyone here—in fact, when you are clinically depressed or anxious, finding a therapist and calling up your insurance company is even more difficult. It’s no wonder that we are vulnerable to the slick marketing of faux self-care.
The time has come for self-care to evolve again, to take on a new definition. And that definition requires looking deeper, turning inward, and developing a reliable internal method for yourself—not one that has been prescribed for you by a wellness company or an influencer, but instead a solution that comes from you.
HOW TO KNOW WHEN IT’S TIME TO SEEK PROFESSIONAL HELP
As a physician, it’s important to me to point out that there is a difference between treatment for a mental health condition—like major depressive disorder—and wellness activities. It’s crucial not to mistake faux self-care (or, for that matter, real self-care) as a treatment for a medical condition. Throughout the rest of the book, I will be pointing out key areas to take note of, how to tell the difference between a clinical condition and something that can be helped by real self-care, as well as indicators for when to think about seeking professional help. At the end of the book, I have included resources for finding a mental health professional.
FAUX SELF-CARE VERSUS REAL SELF-CARE
To illustrate the difference between faux self-care and real self-care, I offer the example of my patient Shelby. Shelby, a thirty-two-year-old married white woman, first came to see me for help managing her depression, which had long been under control with the help of psychotherapy and medication. During her time in treatment with me, she had her first baby. Shelby considered herself someone who had her act together. She had always been on top of her mental health, getting treatment for her depression in her early twenties, and had risen in the ranks of her career at a large ad agency. Shelby loved her job, and she loved getting things done. She had a healthy relationship with her husband, Mark, who had been her college sweetheart. When they decided to start trying for their first child together, they spent a good deal of time examining the various responsibilities they would each be in charge of and committed to an equal division of labor in the home. Together Shelby and Mark discussed all the different scenarios of how their finances would work and how much time she’d take off work because she was the primary breadwinner.
Shelby’s main self-care strategy prior to having her daughter was exercise—she loved to run and also had an elliptical machine. She found that in addition to therapy and medication, daily exercise was incredibly important for her mental health and the health of her relationship.
Shelby went into labor a couple of weeks before her due date, and her daughter, Felicity, was born prematurely. Because Felicity was born early, her suck reflex was not fully mature, and she had trouble latching on to the nipple during breastfeeding. Shelby, ever the problem solver and the one to “get it done,” set out to fix the issue. She took Felicity to a specialist to fix her tongue-tie, and diligently followed the pediatrician’s recommendation to triple feed, meaning that every feed involved three steps: putting Felicity to the breast for a period of time, pumping milk in order to keep her supply up, and then giving Felicity high-calorie formula to encourage her to gain weight.
Despite this, Felicity was not putting on weight as she should and was falling off the growth curve. Each feed was a knockdown, drag-out fight, as Felicity did not like breastfeeding. Each session typically ended in tears (for both Felicity and Shelby). During this time, Shelby, in her sleep-deprived state, tried to find comfort in her typical self-care activity of exercise. She couldn’t run postpartum, so she used her elliptical. However, she had very little time to work out and when she did, she became upset that her body couldn’t perform like it used to. She went to a mommy and me postpartum stress class, but that only added more pressure as she compared Felicity’s development to all the other infants’. The harder she pushed at some of these self-care solutions (which had worked for her in the past), the more disconnected Shelby felt from herself and from her family.
One day in a therapy session with me, Shelby described a new feeling that she was just starting to understand. During the triple feeds, after Felicity and Shelby would have their knockdown fight at the breast, Shelby would hand her daughter off to her husband to bottle-feed, burp, and soothe while Shelby pumped breast milk. In those moments, Shelby found herself looking at her husband with a combination of envy and resentment. He got to spend quality time experiencing the best of their cute little daughter—meanwhile, as a mother, she was forced into the misery of trying to make something work that was clearly not working. Shelby also realized that she was starting to develop negative feelings toward her daughter—she resented Felicity for not getting with the program and breastfeeding like she was supposed to. And, in the same breath, she realized that if she wanted to be the mother she hoped that she’d become, she would have to let go of breastfeeding. Once Shelby made this tough decision, she noticed that she started to feel more like herself. She was sleeping a little more and felt more comfortable in her body. She found herself going on short runs again, without having to force herself. She felt more relaxed in group settings with other mothers.
In his bestselling book Effortless, author and leadership expert Greg McKeown elucidates an important point about decision-making—the difference between methods and principles. He writes: “A method may be useful once, to solve one specific type of problem. Principles, however, can be applied broadly and repeatedly.” [10] Faux self-care is a method—in the moment, going for a run might improve your mood, but it does nothing to change the circumstances in your life that led you to feel drained, energy-less, or down. On the other hand, the work of real self-care is about going deeper and identifying the core principles to guide decision-making. When you apply these principles to your life, you don’t just feel relief in the moment, you design a system of living that prevents the problems from coming up in the first place. In other words, applying a methodology of faux self-care is reactive, whereas practicing real self-care is proactive. To bring it back to Shelby—exercise and the postpartum group were methods that on the surface seemed helpful, but in this new phase of life, they weren’t nourishing her anymore.
By deciding to stop breastfeeding, Shelby was turning to the principles of real self-care. She set boundaries (coming from a large family based locally, she had many relatives who loved to give unsolicited advice about feeding the baby); developed compassion for herself (by recognizing that resentment was building between her and her daughter, and her and her husband); identified her values (in prioritizing her relationships with her daughter and her husband); and asserted power (by using her agency to make a hard choice). Her particular method for real self-care as a new mother was to let go of breastfeeding and accept a new direction that prioritized her relationships.
To be clear, it’s not that exercise or the support group were bad solutions (in fact, psychiatrists often recommend movement as an evidence-based strategy to mitigate mild depression). The issue was that exercise was causing psychological stress because Shelby was comparing her performance to her prepregnancy state. Similarly, in the postpartum group sessions, she was preoccupied with her baby’s performance. Once she practiced real self-care and reworked her feeding plan for Felicity, Shelby found she was able to return to her workouts in a healthier fashion, and she was able to be compassionate toward herself in her moms’ group.
As we move through the book, you will understand how your own methods of real self-care will differ based on your particular situation. But the principles are remarkably consistent. If you start implementing these principles in your life (and you don’t even need to do it perfectly—you just need to start), then you’ll find that your unique methods for real self-care become clear to you.
BUT WHAT IF I REALLY LIKE THE WELLNESS STUFF?
Shelby’s story brings us to an important caveat. I know that some of you might enjoy and look forward to wellness practices—like yoga, meditation, or energy work. I’m not here to shame any of you who like to turn to wellness activities. In fact, in the years since I left the cult, I’ve been known to indulge in a Reiki session or two, even while writing this book! This might sound confusing to you, because the premise of the solution I’m proposing is seemingly counter to commodified wellness and so-called woo-woo practices. Hear me out—one person’s yoga class can be profoundly nourishing, while another person’s yoga class can simply be an avoidance strategy or an escape. Like we just discussed, there are an infinite number of methods you can use to take care of yourself—my goal here is to offer you the guiding principles that you can implement to uncover your own unique methods. Real self-care is not a noun, it’s a verb. So it’s possible for the work of real self-care (boundary setting, self-compassion, and getting clear on values) to point you in the direction of a wellness activity. For example, if you have a hard conversation with your partner about needing space in your week for your yoga class and go on to treat yourself kindly during that yoga class and reflect explicitly about how a yoga practice is in alignment with your values, this is real self-care! The internal work that gets you to the yoga class is the bit that carries forth sustainably and reliably—perhaps in some seasons of your life the method will be yoga, and in other seasons the method will be different. The internal process—real self-care—is timeless.
FAUX SELF-CARE VERSUS REAL SELF-CARE
When you first start out, it can be a little tricky to differentiate between faux self-care and real self-care. The following chart can help you spot the difference.
Faux Self-Care
Prescribed from outside
A noun, typically describing an activity or a product
Maintains status quo in your relationship or family, and does nothing to change larger systems
Common examples: a yoga class, a meditation app, or a fancy face cream
Often leaves you feeling further away from yourself
Typically comes with feelings of guilt (either for never getting to it, or while you are engaging in it because you are neglecting other responsibilities)
Allows you to avoid or brush aside emotional costs or risks
Real Self-Care
Originates within you
A verb, describing an invisible, internal decision-making process
The internal process that goes on for you before you make the choice to attend the yoga class, listen to the meditation app, or put on the fancy face cream
Allows you to get your needs met in your relationships, and can effect change in your family, workplace, and larger systems
Brings you closer to yourself and what’s most important to you
Requires learning to cope with feelings of guilt as part of the process
Comes with a short-term emotional cost, in order to reap longer-term emotional gains
Now that you’re getting a better sense of the difference between real self-care and faux self-care, consider the following questions:
What types of faux self-care have you tried?
When do you find yourself most likely to turn to faux self- care?
What aspect of faux self-care has you feeling the most disappointed?
Have there been certain activities or wellness practices that have helped you?
Are there certain feelings or thoughts about yourself that these activities elicit?
In order to integrate these helpful wellness activities into your life, have you noticed changes in how you talk to yourself or how you navigate your relationships? If so, what changes have you noticed?
As you move through the rest of the book, come back to these questions to distinguish for yourself which activities fall into the faux self-care category and which are aligned with real self-care. Over time, asking yourself these questions will feel second nature.
Chapter 2
WHY IT’S HARD TO RESIST THE SEDUCTION
THE WAYS WE TURN TO FAUX SELF-CARE
What I meant when I said “I don’t have time” is that every minute that passes I’m disappointing someone . . .
KATE BAER
Five years ago, burned out at my job and trying to figure out what I wanted to do next, I decided to spend a week at Esalen in Big Sur, a gorgeous wellness center set on the cliffs overlooking the Pacific. On my resident’s salary this retreat was a splurge, and I went in taking it very seriously. I had certain Big Life Questions I was going to get answered, and I was determined to have it all figured out by the end of the week. I enjoyed the ocean-side sulfur baths, the healing massages, and the avocado toast. And I was militant about journaling and meditating as I searched for answers to deeper questions that I was convinced this retreat would provide.
One day, I met a couple in their sixties who had been coming to Esalen every year for decades. Over a lunch of quinoa and butternut squash, they told me that Esalen was their vacation. I noticed myself feeling personally offended and morally outraged—this wasn’t a vacation! I was here to do serious work! Looking back, I realize this couple was probably more on track than I was when it comes to what wellness can offer us and what’s missing from the equation. Wellness can provide temporary relief, but it can’t change us internally unless we do the work of real self-care first.
