Self-Care, the Right Way

— Pooja Lakshmin, MD, on redefining wellness


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The wellness industry saturates our cultural consciousness, with juice cleanses, organic skincare, and spa retreats flooding our social media feeds. But what does this plethora of dazzling -- and often expensive -- lifestyle products all amount to?

Not much, argues Pooja Lakshmin, MD, a psychiatrist who specializes in women's mental health and a clinical assistant professor at George Washington University School of Medicine in Washington, D.C.

As she writes, "our understanding of self-care and wellness is incomplete at best and manipulative at worst. We cannot meditate our way out of a 40-hour work week without childcare. These wellness products keep us looking outward, comparing ourselves with others or striving for perfection." She details her ideas for achieving true wellness in her recently released book, Real Self-Care: A Transformative Program for Redefining Wellness.

In this episode, Lakshmin joins Henry Bair and Tyler Johnson, MD, to discuss how she overcame her own struggles working in medicine and details practical strategies for real self-care, which, in her words, "isn't a thing to do or buy, but a way to be."

In this episode, you will hear about:

  • 2:15 How Lakshmin's rocky initial foray into medicine led her to a career in psychiatry
  • 5:34 Lakshmin's disillusionment with medicine, her 2 years away from the profession, and what she learned from immersing herself in the wellness industry
  • 10:42 Reflections on the state of the wellness industry
  • 15:52 An overview of Lakshmin's book, Real Self-Care, and what real self-care looks like
  • 18:47 A deeper dive into the first principle of real self-care: boundary setting
  • 24:25 A discussion of how the American healthcare system often exploits doctors and nurses
  • 32:08 The second principle of real self-care: self-compassion
  • 38:44 The third principle of real self-care: knowing your values
  • 45:09 The fourth principle of real self-care: empower oneself to create change
  • 50:43 Lakshmin's advice on getting control of your self-care journey

The following is a partial transcript (note errors are possible):

Bair: Can you tell us what first drew you to a medical career?

Lakshmin: This is a question that sort of gets deep into, I think, all of the different ways in which, you know, family of origin and identity and immigration come into play. So my parents are immigrants from India. My father's a physician. He's an anesthesiologist. He's retired now. So I'm South-Asian American. And it was sort of always assumed that I would become a doctor because I'm Indian, you know?

And I think especially in the Asian immigrant community, in that first-generation community, you know, sort of the model minority, sort of like, oh, well, you're going to be a doctor or you're going to be an engineer or maybe -- gasp -- you'll be a lawyer. Right?

And I was good at school. You know, I was like a valedictorian in my high school. I got into Penn for undergrad and somehow excelled in like, orgo and all the classes. And it was funny. So, at Penn, I was a double major. I was biological basis of behavior and women's studies. And I remember once -- not to throw my parents under the bus, but I guess I will throw them under the bus -- and if you read my book, you'll hear about that more, but I remember having a conversation with my mom at one point where I was like, you know, I really want to be a women's studies professor.

Like, that's really what I want to do. And she was just like, "but Pooja, how could you do that?" You know, like it was just like outside the realm of possibility, you know? And I understand that now after, like, you know, I'm 39, years and years of therapy. I understand that, you know, my parents came to America and they wanted their daughter to have a career that was, you know, secure and had a certain level of prestige and like, you know, always provided for me. Right?

So it's coming from a good place. But, you know, long story, long, I went to Jefferson for medical school and my first rotation was actually ob/gyn, and I thought that I was going to do ob because I wanted to do women. I wanted to work with women, but I hated being in the OR, despite the fact that my father is an anesthesiologist. And I did psychiatry last. And I knew within the first week of my psych rotation that I just knew that psych was for me. I was like, these people are so -- talking about the attendings and the residents -- it's like, these people are so weird and they are my weird people. Like these are my people, you know?

And I just loved it. It just, it just totally fit me. And I remember being worried of, like, what were my parents going to say? What were other people going to say? Because, you know, in medicine, psychiatry is still considered a little bit of sort of like the black sheep, like, you know, why would you go to med school and spend all this time and money if you were just going to become a psychiatrist and sit on a couch and talk to people?

But yeah, that was the right move for me. So it's kind of what brought me here. And then my journey from there has just always been, I was really conflicted about medicine because of all the ways in which it has let me down and has let my patients down and has in the way that medicine treats doctors, right, the way that medicine treats its people.

So I left medicine for a little while and came back. And so it's sort of like an ongoing journey for me of figuring out how to be a psychiatrist, how to be a physician in the way that is aligned with my own values.

Bair: What did you do in the period when you left medicine?

Lakshmin: Yeah. So I talk about this in Real Self-Care in the introduction. It was a very messy period in my life, so I had gone straight from undergrad at Penn, med school at Jeff. I matched at Stanford for my psychiatry residency, got married, moved across the country, and it was my PGY-2 year of psych residency. And I was not only completely burnt out myself because I'd never taken a break, but I was also just really disillusioned.

I was really disillusioned with how little power we actually had as physicians in that, you know, somebody comes into the ER and they're unhoused, and the only thing that we can really offer them is Zoloft or therapy. I mean, we can't even really offer them therapy, right? Because therapy is too expensive for most people. But what this person actually needs is housing. Or, you know, the woman who loses her job because she doesn't have childcare, right? Like Zoloft isn't going to fix that.

And I just felt really, really angry with the fact that I didn't have the resources or the tools to fix this incredibly broken system. And then in my own life, I was just sort of questioning all the things that I thought were, that I had previously sort of held up as gospel. So whether it was like going to the prestigious schools or getting married or doing all the right stuff, sort of climbing the path. And so I ended up leaving my marriage. I moved into a commune in San Francisco that practiced orgasmic meditation. I dropped out of Stanford, and to be fair, I was totally underperforming in my residency because I was burnt out and depressed and questioning everything.

So, ultimately, I left and spent 2 years with this group and studied female orgasm at a neuroscience lab at Rutgers that puts people in fMRI machines and looks at the brain when they're having orgasms. And by the end of that journey, you know, that was 2 years, and I realized that the spiritual world or the alternative medicine world has just as many hypocrisies and contradictions as allopathic medicine. And you really can't just, you know, like you'll never find the solution outside of yourself. Like, no wellness practice, no guru. There is no magic panacea, right?

And so ultimately, I was really heartbroken about leaving this group. But I left the group and, you know, spent my 30th birthday completely depressed, nearly suicidal in my childhood bedroom, turning 30 and kind of facing coming back to medicine and reapplying. And I was really fortunate to get a third-year spot at GW on the East Coast. And ultimately that ended up being the right fit for me.

But also I think in leaving what I later realized that this was actually a cult, you know, and other media reports came out about how dark the story was in this group. But leaving the group was actually what helped me understand that, ultimately, like, you have to make your own path. And that was something that I really needed because, you know, medicine is such a hierarchical system too, you know, and you spend so long thinking, okay, well, I'll be okay as long as I get through. And once I get through internship, then I'll be happy. Once I get through residency, then I'll be happy.

For the full transcript, visit The Doctor's Art.

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