Conversations: Pooja Lakshmin, MD

 

SYNOPSIS

 

Emily speaks with psychiatrist Pooja Lakshmin about her book Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble-Baths Not Included), which challenges mainstream notions of self-care and offers a new framework for cultivating wellbeing.

 
 
 

LISTEN

 
 
 
 
 
 

GUEST

 

Pooja Lakshmin, MD is a board-certified psychiatrist, author, keynote speaker, and contributor to The New York Times. Her new book, Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble-Baths Not Included), a national bestseller, has been featured by Good Morning America, NPR’s Code Switch, The New York Times, The Guardian, and translated into eight languages. Pooja maintains a private practice where she treats women struggling with burnout, perfectionism, and depression, anxiety and ADHD. She frequently speaks and consults for organizations on well-being and real self-care. Subscribe to her free newsletter, Therapy Takeaway. 

 
 
 

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CREDITS

Hosted by Emily Silverman

Produced by Emily Silverman, Jon Oliver, and Carly Besser

Edited and mixed by Jon Oliver

Original theme music by Yosef Munro with additional music by Blue Dot Sessions

The Nocturnists is made possible by the California Medical Association, and people like you who have donated through our website and Patreon page

 
 
 

TRANSCRIPT

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The Nocturnists: Conversations
Pooja Lakshmin, MD
Episode Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman
You're listening to The Nocturnists: Conversations. I'm Emily Silverman. Today's guest, Dr. Pooja Lakshmin, explores these questions in her book, Real Self Care, a transformative program for redefining wellness. If you look at the book next to the title in parentheses, you'll see the words, "crystals cleanses and bubble baths not included", which I think is a really funny hint to the fact that not only does Pooja offer us a new framework for what self care is, but she also deconstructs how we currently view self care in a way that I found to be really novel and refreshing. Pooja is a board certified psychiatrist, a clinical assistant professor at George Washington University School of Medicine and founder and CEO of the women's mental health community, Jemma, she has spent 1000s of hours taking care of women who struggle with anxiety, depression and burnout in her clinical practice. And her book Real Self Care came out in March of 2023.

In my conversation with Pooja, we talk about her personal journey leaving clinical medicine and then coming back to clinical medicine. We talk about the questionable practices of the wellness world and the spiritual marketplace. And we talk about the four pillars of self care, which for me serves as a very helpful framework that I can use to reflect on my own well-being. But before we dive in, let's hear Pooja reading an excerpt from her book, Real Self Care. Here's Pooja.

Pooja Lakshmin
Why listen to me? I've spent the better part of the past decade working as a psychiatrist specializing in women's mental health, in addition to 12 years of education to become a physician and a psychiatrist. In my clinical work, I've spent thousands of hours taking care of women struggling with burnout, despair, depression and anxiety. In addition to treating patients and my academic endeavors, I've poured myself into gender and social justice advocacy. But perhaps more important than my professional accolades, is for you to know that I've been there right where you are. I believe that if I followed the recipe of fancy schools, a prestigious career and marriage, my feelings would catch up. And I'd feel content and fulfilled. I've suffered from burnout, hopelessness, even clinical depression and anxiety. I've taken medication, and been in psychotherapy. I've been through loss, hardship and trauma. And I've made a number of mistakes on my journey, some of which are detailed in this book. A decade ago, while in my late 20s, after spending much of my life up until that point in school to become a physician, I made a drastic decision to the shock and horror of my family and friends. In the course of a year, I blew up my marriage, moved into a wellness commune in San Francisco, and dropped out of my highly competitive psychiatry residency training program. And not just any commune, but one that practiced and taught orgasmic meditation. Convinced I'd found the answers to life's problems, I spent nearly two years with this group, living in their intentional community, working for their wellness startup and spreading their message with fervor. The group itself was organized like a matriarchy, in which women held and wield the power. To say this appealed to me was putting it lightly. I was a former Women's Studies major, but I had grown up in a patriarchal South Asian culture and had just gone through a male dominated academic medical system. How to does a Type A perfectionistic physician find herself in a group focusing on female orgasm? In hindsight, I realized I had been simultaneously searching desperately to find myself in new and exciting places, while also attempting to lose myself.

Emily Silverman
Thank you for that reading. I am sitting here with Dr. Pooja Lakshmin. Pooja, thank you so much for being here today.

Pooja Lakshmin
It's such a pleasure to be here with you, Emily, thank you for having me.

Emily Silverman
So I'm just thinking about what you just read. And a couple of lines stood out. One of them, I think you said, "I've been there, I've been sitting there where you are." As a physician who came up in the medical training system, like a lot of our listeners, you share that experience. And then you make this drastic decision to leave. And then, you make the decision to come back. So tell us about that journey. Because I think a lot of us kind of fantasize about jumping off the cliff. You know, we're so disillusioned. And I think it's important that we also recognize the downsides of doing that.

Pooja Lakshmin
There's so many different ways to tell the story. And that's why narrative is so powerful, especially when we're talking about trauma, the way that you tell it holds so much power. So when I decided to talk publicly about this time in my life, and the decisions that I made, it was really important to me to have it centered inside a book that I wrote, because this was one chapter of my life, but it's not who I am now. So your original question of how did I find my way back and how it all came together in a career like medicine, when you have been on this conveyor belt for so long, and you find yourself in that dark hole, whatever the dark hole is. And there's this fallacy that if you escape and run away to another system, that that will solve all your problems. And I spent two years running away. And to be fair, during that time, I got to do some really amazing neuroscience research, I learned a lot and there was a ton of professional and personal growth. And I came away from that two years ultimately, understanding that there's just as many hypocrisy and inconsistencies in the wellness world in the quote unquote, spiritual world, as there are in mainstream medicine. So I came away realizing that real self care, the real work of building a life that is aligned with who you are on the inside, there's no shortcut to that. That's so obvious, right? Like, we all know that. And because of my own background, and history as a one and a half generation, South Asian American woman and all of the things that come with that, I hadn't really closely examined my values. And so I had to break it all apart, and then come back to what really matters for me and leaving that group and then being really heartbroken, feeling like I'd failed again, and then facing this really, really painful process of coming back to medicine. And it also required me to forgive the system that was so terrible, still is terrible, but understanding for myself that there are good people in medicine, but it's the system that has taken away our humanity. And so when I came back and was able to find a third year residency spot at GW, they actually made the spot for me. And I was able to focus on global mental health, which was my focus at the time, and women's mental health, perinatal psychiatry, I came back a different person, I came back knowing that the system was totally broken. And that my number one job was protecting my mental health. And I recognized that I was the only person that could give that to myself, no mentor, no supervisor, and I've had amazing, amazing mentors. But I've had to recognize that ultimately, my career and my well-being still depended on my own decisions.

Emily Silverman
I relate to your story so much. I mean, my story is different, of course. But in some ways, I'm in that composting time right now, where I'm trying to figure out what comes next. And part of my journey, too, has been turning towards spirituality in a way that I never did in medicine, but then also having this reckoning of like, oh, there's a whole spiritual marketplace. And there's just as much dishonesty and corruption with that world as there is with medicine. And just that discovery, like it almost makes me want to laugh. Because you just can't outsmart it in a way. I'm curious. Tell us a little bit about your practice now. So you're an attending now, you're a psychiatrist, now you came back. I see a very sweet cat, Fifi, she lives here.

Pooja Lakshmin
Yes, that's Fifi. And she just, there's never a podcast that she does not make an appearance on.

Emily Silverman
Well Fifi will be here with us. Tell us where you live? What is your practice? How is it set up and what that MD side of your life is looking like right now.

Pooja Lakshmin
So I think the best way to get there is to just follow the whole thread from graduating from residency and the different choices that I made. So I graduated residency in 2016. And I was really fortunate that George Washington University wanted to hire me as faculty. And it was kind of the dream job, it was in our women's mental health clinic, I would get to do global mental health research. So I was full time faculty for three years as a new attending, which Emily I'm sure you empathize with, that's a rough transition and roll kind of to being an adult, understanding how the sausage gets made. And it's not pretty. And during that time, I had to really think about what do I want? When I first started, I actually was offered the position of Associate Program Director for the residency program. And so I did that for two years. And during that time, there was always the possibility like, oh, you could become a program director, if you want to sort of move up this ladder. That's one of the paths. But I looked around and all the people at the levels above, they didn't seem too happy. I was kind of like, I don't think I want that. I don't think that's the right thing for me. And so after three years, on full time faculty, I negotiated to stay on as clinical or adjunct and to start a small private practice. Because I'm a psychiatrist, this was obviously much of a lower lift for me, because in psychiatry, you don't need to have any real infrastructure. You just need an EMR and malpractice insurance, which is a lot less expensive than other fields, obviously. So. So I started a small private practice that was two days a week doing perinatal psychiatry, and I made the decision at that time to only work with people who identified as women, because that is the patient population that I really enjoyed working with. And I built a supportive community in my time at GW on faculty that made me feel like I had peers and mentors. So even though I was doing this private practice two days a week, I had community, so that helped a lot as well. And then the rest of my time, I supervised residents in our five trimesters clinic, which I enjoyed doing, and I do still do that once a month. I started writing for places like Doximity, I started an Instagram account, which at that time was a very strange and weird thing to do. I imagine when you first started The Nocturnists people were probably like, what do you doing? Definitely, that was my phase. Instagram was nice. I'm not funny enough to be good on Twitter. But Instagram was great for me because you can write the long captions, so it was sort of like microblogging and my page was really focused on perinatal psychiatry, women's mental health, and I got to be me, it was outside of that clinical environment outside of all the bureaucracy. And that was really like kind of a full time job, because you really have to like post every day you have to put out really good stuff. But through probably like a year of really doing that the New York Times found me on Instagram and so then I started writing for the New York Times and that led to meeting an agent who decided to take me on for this book, Real Self Care. And then I found a Gemma, this women's mental health digital education platform. I have two colleagues that are part of our team are growing together, Dr. Kelly Cyrus and Dr. Lucy Huttner. And then the rest of my time is my writing. And I do some public speaking and consulting.

Emily Silverman
You mentioned earlier that you were a woman studies major, and that you've always had this passion for mental health in women populations. So tell me a little bit about that interest. And then also, is this book primarily written for a female audience? Can it be applied to men as well? Or is it really more targeted toward women?

Pooja Lakshmin
When I think about that question, there's two stories that stand out for me. One is growing up in an immigrant South Asian family, I was one of two daughters, I was the oldest, I have a cousin, who is about six months older than me, and not to throw my parents under the bus because they are great. And they have sacrificed so much for me and my sister to have the life that we do. And for me to have the luxuries that I have now and the privilege of being able to have an existential crisis in my 20s and blow up my life and come back, right. But growing up, I wasn't allowed to date, I wasn't allowed to drive a car more than like 10 miles outside of our neighborhood. And the running refrain was, well, he's a boy, your husband's a boy, so he can do these things, but you're a girl, it's different. And that's the world that my parents grew up in, you know, my mom left India when she was 23, left her whole family to come to the United States. My dad, he came to the US when he was like 10. So gender was just such a huge part of my life growing up, and I was raised Hindu. So another piece of that upbringing was even just things like, well, you can't go to the temple when you're on your period, because you're not pure, right. But boys don't have to deal with that. When I first started in medical school, I thought maybe I might want to be a surgeon. And I remember a professor sat me down, he took me aside, to give me a talk to tell me that I didn't have the personality to be a surgeon, because to be a surgeon, you need to be able to lead in the operating room. And he didn't think that I was a leader. That's when this was like 2006, maybe. I hope that that type of conversation doesn't happen anymore. But you know, it probably does. But so then I went into perinatal psychiatry and all this stuff is in the background of my brain. And then I'm a practicing perinatal psychiatrist, where my bread and butter clinical work is taking care of patients who have postpartum depression or postpartum anxiety or women who have a history of anxiety or depression, and are on an SSRI and trying to figure out what to do. Is it okay for me to stay on it? Right. So prevention, and an evidence based intervention for prevention of postpartum depression or postpartum anxiety is to get four consecutive hours of sleep in the postpartum period. Seems simple enough, right? But if you've had a baby, you know that that's a lofty ask. And it also is completely determined by your social determinants of health. Right? How much social support do you have? Do you have family that can come help? Are you a single parent? Do you have paid parental leave? Do you understand your choices in terms of how to feed your baby? So I realized that maternal mental health was a social justice issue. The easy part of my job is prescribing Zoloft. The easy part of my job is providing psychotherapy. The part that's infuriating to me is that so many of the problems that my patients have lie within our social structures and our laws and policies.

Emily Silverman
You said that you realize that mental health among women, especially peripartum women, was a social justice issue. And that rings so true. And I've just been thinking a lot about the fact that just a few generations ago, women weren't really in the workforce. They were confined to this role. They had no choice that they belonged in the home, pregnant, giving birth, raising children. And that was kind of it. And that's really changed in the last couple decades. Women have moved into the spaces that have been traditionally male. But men haven't necessarily moved into spaces that have been traditionally female. We do have some stay at home dads and sharing of that workload, but there's still a lot of stigma against men who do that work. I'm just thinking about presidential candidate Pete Buttigieg, and it has been adopted twins and I remember he came out that he was going to take paternity leave and got a lot of grief about that from men online on social media. Saying that, you know, it wasn't masculine, to take time out to take care of a baby, and so on and so forth. So it's clear that this has all happened just in the blink of an eye, over a generation or two. And we as a society really haven't figured out how to organize ourselves around these new changes. How do families work now? How do households work now? Who does what? You know, before it was a script, and now there is no script, and people kind of don't know what to do. So I'm wondering how you think about progress in women's rights? And then these new questions that flow from that progress? And how do you think women are orienting themselves in that conversation? Do you think they are thinking about it in those terms? Or do you think they're more in the mindset of like, oh, this is how it is, this is how it's always been. And I'm just a failure.

Pooja Lakshmin
I wrote an article for The New York Times a couple years ago that was called this is betrayal, not burnout. And it was about what moms employed outside the home were feeling during the height of the pandemic. And the article focused on the systems at large. And a lot of the comments were, well, why didn't you call out men more? Why didn't you say that dad should be doing more? And I thought that was interesting one, because it was also assuming cis hetero relationships. But when we make it a gender war, we actually do everybody a disservice. Because when you make it a gender war, then you're pointing the finger and you're ignoring the fact that we don't have federally mandated paid parental leave. And the fact that childcare is still hugely exorbitantly priced in many cities in America. So all these other systemic issues that could be solved with humane policy decisions get swept under the rug, when you say to men, cis hetero men, like, "hey, we just need you to do more dishes." And that's why I'm your question was exactly the right question. Because it's not about yes, women are in the workforce, right? Although we could talk about the pandemic and how many women left. We're in the workforce, even though it's still hostile, I would say, especially corporate America, but the conversation also needs to be happening the other way of bringing men into the home. In Real Self Care, I interviewed Bridget Sheltie, who is the director of the New Life Lab, and she spent decades working on gender equity in the home and this exact question, how do we make domestic labor more equitable, and it does come down to actually wages and paying for the invisible labor. When we're drowning, the way to swim back to shore is real self care. And that comes with a discussion of equity. So a patient that I worked with, she came to see me originally for her depression and her anxiety, which we got under control. And then we started working on some of the harder issues and therapy like, what do you really want to do with your life? What makes you feel energetic? What do you really care about? And what came out from that was the fact that she had two kids, but her husband had never taken a paternity leave. Because he worked in startups, and tech, and he was always on really small teams. And he just always felt like it would be too much of a burden on everybody else, for him to take a leave, even though they had two kids. And so when she got pregnant with her third baby, her real self care was having multiple really hard conversations with him to say, "hey, look, I just need you to ask, I need to know that we're in this together, I need to know that you're willing to take risks with your career, because I've had to, but you haven't. And I need to know that you're in this with me." And so he did. He asked for paternity leave. And they said yes. And that change went on to impact everybody else who worked at that company. And she wasn't trying to be an advocate or an activist. She was just trying to not hate her husband. Right? Like, but that's the process of real self care. But you have to know what it is for yourself. I can't give you that prescription. You have to know in your own life. What is that conversation? What does that boundary, what is that ask? I am hopeful we have come a really, really long way. Of course, there's a huge way to go. Right now in America, we're seeing the rolling back of so many human rights, and things are very scary. That's why the real self care message is so important because you actually do have power in your own life, in your own family. And you know, Gloria Steinem said that the personal is political. That's so true. It's really about the choices that you make and the way that you show up for yourself and it has a cascade effect.

Emily Silverman
There's a few anecdotes in the book about patients of yours, women who are so busy taking care of everyone else. And then you pause them. And you ask them, "What do you want?" And they don't know, because they've never really stopped to ask. And you talk about the conditioning of women, you know, the real way that society has conditioned women into this mode of self sacrifice, you even talk about something called martyr mode. And you will also talk about how it's really complicated and about how some of us and I'm sure I've been guilty of this myself, even take pride in being in martyr mode. There's a quote in your book where you say, on the one hand, martyr mode is about experiencing suffering and destroying yourself for the sake of others, whether it's your children, family, or coworkers. On the other hand, it's about relishing that sacrifice and paradoxically making sure that your smallness is seen. And I was like, "Oh, I just love that you said that." Because I feel like a lot of people would be afraid to say that or to acknowledge that part of it. But I think it's so true. And it's just there. And so I'm wondering what your thoughts are on before we even get to what we want, like, how do we unlearn some of that conditioning, that self sacrifice that martyrdom? I'm not saying that things like generosity and care are bad, but obviously, that's different than martyr mode? And so how are you thinking about that with your patients and with yourself?

Pooja Lakshmin
I think this is an epidemic in medicine, I'll say. Physician, women are some of the worst offenders when it comes to the martyr mode. Like, we love to be the superheroes, we just love saving the day, we love the kudos that you get from picking up that shift when nobody else can, right, for just making it all work. And I like to say the quiet part out loud, which is that there's so much ego in that we get off on it, and just being the one that is sacrificing everything. And so the first step is understanding that you're doing it. And there's no shame there, because society gives us these kudos, and then you become dependent on it. And then the next step is to sort of identify how it's playing out. What are the patterns? Where does this show up most often for you? Are you doing this in your work life? Are you doing this in your personal life at home with your family everywhere, right? I'm like really looking at what are the costs when I sacrifice myself for everybody else? I'm quietly or maybe not so quietly, resentful. I also say that a lot of times when I asked my patients that question, they get mad at me. Because they're just like Pooja like don't well, they say Dr. Lakshmin, "Don't you know, like how much is on my to do list? Like how dare you ask me what I want?" Which I think is like, that's telling, right? When that's the response. So before you can even get to what what do I want? You have to learn how to set boundaries. And that's why boundaries are principle one of real self care. And my take on boundaries is a little bit different in that I think of boundaries as the pause. I had an aha moment about this. When I graduated residency in 2016, my mentor, Dr. Lisa Catapano, she took me out for lunch. And she was like, I have one piece of advice for you Pooja, you don't need to answer your phone, you can just let it go to voicemail. And then you can listen. And you can decide. Sometimes it's the front desk, they have paperwork, you call them back, you say like, "Oh, I'll do it. At the end of the day." Sometimes it's a patient who needs a refill. And then I use my judgment, "Oh, this is somebody who, if she misses a day of her stimulant her ADHD is so bad that she might get into a car accident or lose her job. I'll put that refill in." But I decide. So your boundary is the pause. And then you can say yes, you can say no, or you can negotiate. So boundary isn't always no. And the truth is too, talking about social determinants of health, no isn't available for everybody all the time, depending on the color of your skin, depending on your gender identity, depending on how much money you make, and how much you need this job. There are real consequences to know. But the pause, the pause is always there. That's accessible. And so if you are somebody who's in a place right now, where you're drowning, and you're just like, this is all terrible. You might not be able to say no, but you can use the pause and then you can set a goal and you can say, "You know what, a year from now, I want to be closer to being able to say no, what do I need to put in place in my life? What decisions do I need to make, so that 'no' is more available to me one year from now than it is right now?"

Emily Silverman
These four pillars of real self care, they're doozies. I mean, so the whole thesis of the book for the audience, and forgive me if I butcher this, but it's that these four pillars and you say, setting boundaries with others, changing how you talk to yourself, bringing in what matters to you. So this values clarification. And then the last one is using your power for good. And I want to hit on that one in a minute. And you have exercises in the book, questions to ask yourself, fill in the blank stuff, like this book is just so practical, and really walks you through all four of those pillars and how to engage with them. And the idea is like, this is what real self care is, right? Like, real self care isn't necessarily a juice cleanse, or a yoga retreat, although those things can be good. But it's not only those things that amount to what self care is. And you talk about the need for us to transform our inner landscapes, you say it's an inside job. This is like a pretty radical way to rethink self care, which is why the book I'm sure is like skyrocketing to the top of the New York Times bestseller list. What has the response been to this book, because in a way, it's a lot easier to just like drink juice than it is to like, do this massive internal transformation. And I'm sure a lot of people are saying, like you said, with the to do list, "I'm too busy to do this." How do you make the case to your patients and friends, that the short term investment of doing this work on oneself, pays out in the long term, because it's just such a massive way of shifting the way you orient yourself to the world.

Pooja Lakshmin
It's funny that you mentioned this because I was doing another interview a couple of weeks ago, and the host that I was talking to was like, "I feel like this book is like a secret Trojan horse." I'm like, yeah, it totally is. And to clarify a little bit, one thing that you said I the way that I think about the yoga and the massages and the meditation is that it's a life raft. And sometimes you do need those life rafts. But real self care is your swim to shore up plan. You know, I'm a pretty terrible salesperson. So I kind of use the motivational interviewing approach, which is that I'm not here to convince you that you need this, because that never works. I think you have to let folks do their turmeric latte, do all the essential oils, submerge themselves into the sensory deprivation tank. I left residency, and I totally went woowoo for two years, I had to come to it myself. So there's an aspect of this, that is sort of like, it's here when you're ready. And if you're not ready, or if you don't totally see it, like that's fine, do all the things. And I think that's important. Because even though this book is for sure, a prescriptive book, there's lots of exercises, there's lots of ways to really engage with the suggestions that I'm providing. I don't have all the answers. And I don't really have your answer, either as a reader that you have to do the work inside this book and understand what your values are. And then you have to come to your own real self care solution. So I think this is the type of process that not only do you have to come to it yourself, once you come to it, you understand that it doesn't end that every new season of your life, every transition that you go through, whether that's becoming a parent, whether that's switching careers or jobs, whether that's taking care of your own elderly parents or becoming sick, all these different things, that you'll go through another process where you have to reevaluate what your values are, where you'll have to relearn self-compassion. The good news is that each time you cycle through it, it gets a little bit easier. You sort of have created a mental map for yourself, you understand what it looks like when it's working. And I actually find that to be a hopeful message. Because then there's less of this pressure, like you need to figure it all out right now. Emily, you were talking about yourself being in kind of a transition phase in terms of your clinical practice and the podcast and your creative work. And my thought process in that type of stage is, again, to keep reminding yourself that there's no one right answer, that each choice, each decision that you make during those times leads to the next one. And that inner work ultimately keeps building on itself to get to the next place.

Emily Silverman
You just mentioned self-compassion, and that's one of the four pillars change how you talk to yourself. And you mentioned this 2016 survey conducted by Weight Watchers that found that women criticize themselves on average, eight times a day, with almost half reporting the self critical thoughts started before 9:30am. And 60% of women in the survey said they had days in which they criticized themselves non-stop. What is going on with us? And how do you turn that voice off? Or at least dial it down? I think in the book you talk a little bit about, it's not an on-off. It's like, even if you dial it down, that's a form of success. But talk a little bit about like, why do we do this to ourselves? And how do we stop? We do

Pooja Lakshmin
it because we're internalizing these oppressive systems, we're internalizing white supremacy, we're internalizing misogyny, we're internalizing end stage capitalism. And so when you live in an economic system, and a social structure that is built upon slavery, that's built upon a capitalist model of extracting productivity, then you believe that your value is inherently connected to these roles that you hold. And the roles are roles that are connected to productivity. So whether that's doctor, whether that is mother, so I want listeners who are nodding their heads and saying, "Yeah, I do that all the time, I beat myself up", I want you to know, like, it's not your fault. It's coming from the outside, and it seeps in. So it can't really be turned off. So the volume switch, the understanding that this is just one voice that's running through your mind. But it's not the truth. It also doesn't need to be your moral compass. Right? It can just be one voice that's there. One of the strategies that I propose, when we're talking about self-compassion is this idea of good enough. And that comes from the work of Winnicott who talked about the good enough mother, and I kind of apply it to this self-care framework where instead of berating ourselves for being selfish, and instead of running towards self-less, what if there's a middle path, and it's good enough? I'm not saying that every choice that you make in your life can be centered on you, I'm not proposing that your preferences or your desires are always going to be the priority. That's one not possible. And two, that's not a healthy life, either. Right? What I'm saying is that you can just at least consider yourself part of the team, you can actually be on the team, as opposed to you always being the one that's managing the team, and taking into account everyone else's stuff. What if you were on the team too, and like once every five times, your thought considerations, preferences are part of the mix.

Emily Silverman
You know what this reminds me of? I love Saturday Night Live. And it was this Christmas time sketch. I think Kristen Wiig was the host of SNL. And it was a musical video like a song. And it was a big family, it was a mom and dad and a bunch of kids. And it was Christmas time. And it's like, "What gift did you get? What gift did I get", and someone gets a toy truck, someone gets tickets to a concert, and the mom is like, and I got a robe. And it's just like, nice cozy robe. But then it just gets more and more bizarre. And it's like, I got an airplane, I got blah blah blah, this that. It's like the gifts getting more and more extreme. And then it just keeps coming back to the mom. And then she keeps being like, "...and I got a robe. And I got a robe." And it's like, she just gets a robe. And it does make you wonder about like, is she on the team? And the way that she has trained her family to treat her, like you say about the pause like If anytime someone calls you, you pick it up right away, or anytime someone emails you, you respond right away. You're training them to treat you as that reactive responsive energy. But if someone knows that if they ask you to do something that you're going to consider it with your needs in mind and maybe not respond right away. Like they might shift the way that they orient to you. So anyway, I just had to bring up that SNL music video because I felt bad for Kristen Wiig that she got a robe and nothing else.

Pooja Lakshmin
I love that. And I think that's absolutely right about training people how to treat you. That's part of the cascade effect and how when you model boundaries when you model making decisions according to your values, it gives other people permission to do the same thing. In academics in particular, the reward for being a hard worker is more work,

Emily Silverman
right? And you said your patient who asked her husband for the third child, "Hey, can you ask for pat leave this time?" And then he did and then he got it. And then it changed for the whole company. And I think what happens there is you have other men in the workplace, seeing someone who they like and know and respect, taking pat leave, and then maybe they think to themselves, like maybe I could take pat leave. And so I think you're exactly right that that modeling effect. I mean, this is another one of the arguments of your book is that real self care actually ripples out and transforms the external world? Yes.

Emily Silverman
I want to ask you about power, which is related to the fourth pillar, I find that many people treat that word power like it's a dirty word, and like, it's inherently bad, and that to want it or claim it or have it makes you like, evil or like a narcissist or something like that. But you make the case in the book that power is extremely important. You also acknowledge that power is not given up easily. The Gloria Steinem quote, you mentioned her earlier, she said, "Power can be taken but not given." In other words, nobody wants less power, they are not just going to give away power, just because they're nice, you know, if you want it, you have to take it, you have to seize it. There's also a beautiful quote from Audrey Lord, which says. "Your power is relative, but it is real. And if you do not learn to use it, it will be used against you and me and our children, change did not begin with you. And it will not end with you. But what you do with your life is an absolutely vital piece of that chain." And then I'll just add that I was talking to my husband about this the other day, and he said something that I thought was kind of elegant, which was, "if you're weak and good, you're wasting your goodness, if you're powerful and bad, you're abusing your power. But if you're good and powerful, you can make the world a better place." And then I guess the last one is like if you're weak and bad, you're just shitty and irrelevant. Which is, and I know that there's no such thing as good and bad. And you know, good and evil, black and white, like it's much more muddy and gray than that. But I do see a lot in the discourse these days about power and systems of power and it being bad. And I'm just wondering how you think about that word.

Pooja Lakshmin
For me the word power is kind of value neutral? Because it really depends how you use it. Do you use it to bring power to those who have less than you? And are you willing to take risks in order to enact that. In Real Self Care when I'm talking about power, I'm connecting it to race and identity. Audrey Lorde was the one who really crystallized the phrase, "self care is self preservation", she was a black queer thinker. When you live in a system like America that does have a caste system, the people at the lowest rungs of power are often the ones who are burdened with trying to bring about change. And so you also can't really talk about power without acknowledging where you are on the power structure. And so when the discourse is like, power is bad, we shouldn't talk about it, you shouldn't want it, that's like a very puritanical lens, I think to power. But instead when it's something that we openly acknowledge, like, "Okay, I'm a woman of color. So I have darker skin, my parents are immigrants. So that comes with some disadvantages. On the other hand, my father was a doctor, they were able to pay for me to go to school, including medical school without student loans." That's a huge privilege. Huge, huge, huge. I have a partner now who has a stable employed job. So I'm on his health insurance. So that enables me to take risks with my career. And when I can talk about that openly, and say like, that's what my landscape is, then it opens up space for other people to acknowledge that in their own lives, they have aspects where they hold power or privilege and then they've been impacted by systems of injustice and my co founder at Gemma, Dr. Callie Cyrus, she is a black, queer shrink. She's at Johns Hopkins right now with an academic appointment. But she was at Yale doing a lot of DEI medical education. She has really influenced my thinking so much on this and kind of helped me name and verbalize my thoughts on this issue in the context of race and identity in a way that I hadn't fully put together before working with Callie and growing Gemma together. So I think that it's so important for us to talk about, it's so important for us to have models of being responsible with power, and a path forward for understanding how to do that. So one of the decisions that we're making at Gemma right now is as we grow, making sure that we're bringing in BIPOC women, but then also acknowledging that right now we can only afford freelance labor. And to be totally transparent, there's more white women in the labor pool that can take on a freelance gig for a couple hours a month. And so like, how do you reconcile that then? And then what do you do to make it equitable and stay aligned with your values as the people who are trying to build this organization?

Emily Silverman
Yeah, that makes a lot of sense to me, because I'm thinking about how it's very difficult to change the world, it's very difficult to effectuate new social movements, political movements, cultural movements. Without power and power can come in so many different forms, it can come in the form of a job, a position in an organization, political position, it can come in the form of having a million Instagram followers, that's a form of power. And I think those are the ways to spread ideas and to make change. And if we have this narrative, that power is bad, then I think that's really unfortunate, because then the people who historically haven't had power might be shamed for wanting it or getting it or wielding it. And I don't think that's where we should go. I think, what we want, and what we need is people who traditionally haven't had power to then have it and then use it and then make the world a better place. And that includes women, and that includes people of color. And that includes so many different types of people. And so I just really appreciated the way that you discussed power in this book as the fourth pillar, not just thinking about power in society, and how it's distributed and how we use it to make changes in the world. But even this idea of like reclaiming your power, it's almost like an energetic thing, where you're kind of taking back some of your power. And something as small as like pausing before responding to an email or not answering the phone immediately, every single time that is a way of claiming power, maybe that's a different way to think about power.

Pooja Lakshmin
Well, it's just a different level. And you have to understand the personal part before you can think about the macro effects too. The personal aspect of power is about choice, an agency, this time is mine, I get to decide when I respond to a text, yes, there will be consequences. I get to decide if those consequences are something that I need to worry about.

Emily Silverman
We are a show that values storytelling, and maybe to close, we'll bring it to storytelling. You talk about the stories we tell ourselves, and how you can take any objective series of events, whether it's "I left medicine to join a wellness commune", or any other sequence of events. And you can sort of tell that story in two, three, four, five different ways. And it's all about the way that you tell it that can influence how it's received or even how you receive it yourself. You talk about this idea of dialectical thinking, so the ability to reconcile seemingly opposite points of view. So a lot of people get caught in this question of, "Am I a good person? Or am I a bad person?" And how it's almost the wrong question. And when you are grappling with your story of leaving medicine, I think you asked someone once, "Was I just being naive and irresponsible? Or was I actually following my instincts in a way that was actually really good and healthy?" And that in a way, it's both and that's okay. And you also talk about the value of turning up the complexity of your story. How would my inner optimist narrate this story? Or how would the inner wise woman of myself narrate this story or the quirky version of myself, the stand up comedian version of myself, and then imagine these voices engaging with each other. And I thought that was also just a really cool and playful way to think about it. So maybe to end since we're a medical storytelling podcast, talk a bit about the role of story and storytelling in your own life or in real self care.

Pooja Lakshmin
I think that storytelling is everything. It's how I first came to writing with the narrative work of in my past life doing qualitative research, I was always so interested in the stories of the women that I was talking to, and it's how we connect with people. And as I've been on this book tour, I've come to understand that storytelling is a really important skill to have as an author, as well, to really able to bring to life the points that I'm trying to make and help folks understand that no matter where you are on the map that this is accessible. There's a lot of folks out there who are giving answers. And so much of my work is about saying, "hey, there's actually millions of different answers. And everyone's answer is different." And so I think for me and telling the stories of my patients and telling my own personal story, and facing the nuances and the dialectic of that, I think that was my way of really bringing storytelling into not only real self care, but also this season of my life, where I'm talking about this work. I'm reaching new audiences and having conversations that are quite different than the ones that I was having a couple of years ago.

Emily Silverman
I think that's a great place to end and I want to say thank you so much. I have been speaking with Dr. Pooja Lakshmin, about her new book, Real Self Care. I think as Pooja said, we in medicine, especially women in medicine definitely could benefit from some of the discussions in this book. And so I encourage you to pick it up and check it out. I found it to be a really, really helpful way of reframing what self care is and what it means. And yeah, just really grateful for you coming on to chat with me about it today.

Pooja Lakshmin
Emily, thank you so much for having me. And I will just also add, since I am technically supposed to be selling a book that there's also an audio book, so if you'd like to listen to your books, I do narrate the audio book. It's on Audible. And thank you, Emily, again for having me. This was just such a lovely conversation.

Emily Silverman
Thank you. And we also have I forgot your cat's name. Fifi, we also have Fifi who has circled back I think Fifi consents that the interview is rounding to a close. So thank you Fifi for coming back. It's nice to see your furry face too.

 
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