Psychiatry & Psychotherapy Podcast - Real Self-Care with Pooja Lakshmin

Episode Date: March 22, 2023

On this week's episode of the podcast, we interview psychiatrist, author, and founder of Gemma Women, Dr. Pooja Lakshmin. Dr. Lakshmin founded Gemma Women for the purpose of educating women on cultural and social structures that impact their mental health. Gemma also provides community groups, evidence-based conversations, and courses covering topics such as stress, inequity, and structural violence. In her new book, Real Self-Care, she discusses personal experiences that led her to create this transformative movement to redefine wellness. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video.

All right, welcome back to the podcast. I am joined today with a fellow psychiatrist, Pooja Lachshman, and she is someone I've known for a while on social media. She does a lot of women's mental health, perinatal, postpartum, anxiety, depression, self-help for physicians. And she wrote a book called Real Self-Care.

And so it was a good time to finally get you. you on the podcast. So welcome to the podcast. It's so great to be here, Dave. I'm so excited that we're finally getting to be face to face virtually. So I'm excited for this conversation. Yeah. I was, it's like when I started reading your book, I was expecting something very different. And I was almost like shocked by some aspects of your story. For example, like right in the beginning where you're talking about being a part of that, what sounded like a cult for like two years. and really looking for self-help in the extremes. Yeah.

Do you want to mention anything about that? It's probably not the best place to start, but it was like... No, it's, I appreciate... It's funny because as I was writing the book, and I'll say for folks that are just meeting me for the first time, you know, like Dave was saying, I'm a psychiatrist, a board-certified psychiatrist, I'm a clinical assistant professor at George Washington University.

I graduated residency in 2016. So I've been practicing for, what are we, we're in 23 now, so like six or seven years. And I have a private practice in women's mental health, but then I also supervise in FGW. We have a clinic called five trimesters. And in about 2018 was when I started my Instagram account and started doing this social media thing as a psychiatrist. And that's when Dave and I connected. And my Instagram account, which is what led me to writing for the New York Times, which

then led me to getting this book deal. And so it's like, it's, um, that's like my, that's my professional identity now. And I'm 39 years old. But a decade ago when I was in my late 20s, I blew up my life, basically. And I started the book with this in an introduction, because I kind of just wanted to put it out there as like, this is where I'm coming from. And, you know, I, my parents are Indian. They're immigrants. I, prior to that point was like, I did all the good Indian girl things. You know, my dad's a doctor. He's an anesthesiologist, which is funny in itself, me being a psychiatrist.

And he being an, he said once to me, he's like, I really love patients when they're asleep. You know, so. Yeah. But, you know, I, so I went to the Ivy League schools. I went to med school. I became a doctor. I got married. And then at about like 27, 28, I was a PGY2 in psych residency.

And it was sort of like, okay, I've seen. checked off all the boxes. I've done everything that I'm supposed to do. And so now I can be happy. Like, let me try and be happy now because I did all the stuff. And I found I didn't know how to be happy. Like, I didn't know what to do because I was so empty inside. I had just focused so much on like all of the achievements, which I think, you know, especially for someone who's in medicine, like, you know, like, right? It's like you're just going on that treadmill, on that conveyor belt. and you say to yourself, oh, like, well, after med school, I'll be able to have fun. After internship, after residency, after fellowship, right?

And it's just, it never comes. So I was in that place. I didn't know how to be happy. And then as a resident in psych, I was just really disillusioned because, you know, I thought that I was becoming a doctor to really help people, right? Like just why most people go to med school. but then, you know, you have a patient who's unhoused and they come into the ER and the only thing that you can do is give them Zoloft when like what they really need is housing. But like I can't do anything to get you housing or like a woman who, you know, loses childcare for the third time in a month. And so she's getting fired. And it's like, okay, well, like we can talk in therapy, but I don't, I can't fix this problem for you. And so I was, I felt betrayed actually. actually, like I was sort of sold this shoddy set of goods in terms of like what the compact was for medicine.

And so I was super destructive. Like I was really angry. I left my marriage. I moved into a commune in San Francisco that was based and studied a female orgasm and female sexuality and meditation. And then I couple like pretty soon after moving into that commune, I dropped out of my residency program. So, you know, my Indian parents were like really, really happy with me and all of my friends, you know, and I had been like valedictorian in my class. And so, you know, everyone's like, what happened to Pooja? Wow. But it was like I was so angry at traditional medicine, at mainstream medicine. I was like, I'm just going to go to the other side. I'm going to go to this like woo-woo, spiritual wellness worlds. And I'm going to find the answer there. Like these people are pure, right? Like these people actually know. And what I found after those two years was like, no, there's just as many hypocrisies. There's just as many contradictions.

You can never find the answer outside of yourself. Like, you have to come to your own answer. Can we like slow that down? Because I'm like, okay, how are you like, because I'm like really interested in Colts and brainwashing and the seduction into that because I feel like, and I think for those of you who are wondering how this applies to self-help, like, there are so many seductive solutions to self-help that are really commercialization of, you know, pain and suffering. And I think you speak to that, and we're going to get to that. But I think, like, there's something

about, like, yeah, as I listen to it, I'm like, yeah, there's something nice about this. This fantasy of, like, I'm going to leave all this medicine stuff and just do, you know, something very different. There's something, yeah, I don't know. What was like anything more about the seduction of how you were pulled into this or like what that taught you? Yeah. Like some of the deeper layers are, so when I was a resident, right, that PGY2 year for psychiatry is a really rough year, right? It's like you're inpatient.

You're taking care of some of the sickest folks. And it's psychologically, I think, as a trainee, that's a really rough year. And we had a patient who died by suicide on the psych unit where I was training. And that hit me really hard. And then the other thing that happened in my program, and this isn't specific to that program. Like this is like, this happens everywhere, right? Right. Is there was a suicide, a resident suicide at that program.

And I remember thinking at that time, like, I was just like, what is this? Like, like, here are people at this prestigious place. Like, we worked so hard to get here. And we're miserable, you know, to the point where, like, we're killing ourselves, right? And then we're also seeing patients that are, like, suffering so much. And, like, I just felt so hopeless. So what happened is I, it was like I, to make sense of that, I had to completely demonize the whole medical establishment in my eyes and then choose the thing that was like the exact opposite. I mean, it was essentially kind of like splitting, you know, because I had to like make someone the bad guy and then I had to find the quote unquote good guy.

and this group, they were connected with a research lab at Rutgers in New Jersey, which is one of the, it's one of two neuroscience labs in the world that studies orgasm using fMRI imaging. And so I spent two years with that amazing research team, like getting to learn how to do fMRI imaging and like the sensory cortex and, you know, climax and orgasm and, you know, all. So it was like there was like the science aspect to it that really spoke to me. And but ultimately I think the seduction comes in like demonizing something, whatever the place where you had, where you felt betrayed. And then something else is sort of like rescuing you. And but ultimately then you find out that like there isn't like an external rescue. You know.

You talk about how like initially you weren't kind of allowed into the inner circle. And, and, you know, then you talk about later and, you know, and this is a small part of your story, I know, but you talk about how the FBI got involved eventually, you know, and I looked it up and it seemed like there might have been some prostitution going on or some, I don't know what actually was the truth of it. But yeah, was there a moment when you were. like, oh, this is an unhealthy culture, but I've been led to believe it was a lot more healthy than it appeared. Yeah. So I actually, so I was with the group only for two years in 2012 and 2013, and I didn't find out about any of that FBI stuff until 2018 in the media.

I found out in the media. Yeah. So all of that. So when I left the group in 2012, 2013, I was leaving from a place of, I thought I had failed my spiritual mission. Oh. Yeah. Huh. So I didn't know, like, I found out about just how dark all the stuff was in the group with the rest of the world.

And so everything, every time something comes out about this group, it. actually, and I've been in, and I'm maybe I'll just back up too, just for folks that are just listening for the first time and are like, who is this person? Um, you know, after that, I left in 2014, 20, I left in 2013 and I was really privileged to still be a doctor, right? Like, I, I could still come back to a career. I had a family who could take care of me. Because I had all these resources and privilege, I was able to get back into therapy. actually with my therapist that I used to see when I was in med school. She was so gracious and took me back. I got back on SSRIs, got treatment for my depression. And then once I came to GW, where I ultimately came on the faculty, I got into psychoanalysis with my analyst who I still see now, although she's retiring in December, which I'm very sad. But I've been in analysis, like, you know, on the couch three times a week, I guess like seven years now. So I have spent a really long time. unpacking all of this and processing this. And another kind of shout out, along with my analyst

who is in DuPont Circle, one of my mentors in medical school was Salman Aktar, who is like, you know, one of the big, most famous psychoanalytic people. He helped me so much during that really dark time. Like, after I left the group, he sort of held my hand and, like, guided me. me back to medicine. So all that to say that I didn't, I found out with the rest of the world how dark things were. And each time something comes out in the media, it is a whole other kind of aspect of my own internal processing.

And in the book, I read about the fact that, like, you know, one of the things that I've worked on in my own psychoanalysis is, like, what it means that I was a doctor, physician with them for two years speaking publicly on their behalf and like legitimizing this group, which I believed in at the time I believed in the practice that I was doing and that they were, you know, kind of propagating. And like it's still really hard for me to like use the word victim because I feel like it just comes with so many connotations. But I think there's so many layers there. And I guess it's still hard for me to think about the like, you know, the fact that When I left, I really felt like I had, it was like leaving a religion, you know?

It was like that feeling where you feel like you have failed and like you were supposed to have this, you were supposed to be strong enough to like fulfill your calling and you didn't. And so now you have to pick up and, you know, so. Yeah, it was. It's just I have chills like even talking about it right now. So maybe we'll move on to something else. But you know, one thing I'm noticing and I think it's. it's like you've done so much work that this is not your identity anymore.

And your identity is really, I think you share this in the book because it's like, hey, I've really searched. Like I've really, really searched. Like no one can tell me and like pull over some gimmick on me at this point because I've seen both sides. I've seen and I've seen how charisma and how charismatic people, maybe. people that are more like dark triad narcissistic people like can pull over you know can can pull things on us but my identity is not that stuff it's i don't see you and your identity at this point as like like that's why it was so shocking to me when i read this and i was like oh wow like this is someone who's really

suffered in a way you know because it's like when you yeah when you go through something like that it's like wow and i think maybe the lesson or like one of the take all that I've, that maybe is helpful for folks is so that when I came back, right, to medicine and GW and I graduated in 2016, and at GW, we have this clinic called five trimesters, which is a perinatal psychiatry clinic. And I was recruited to come on faculty and, you know, be a supervisor in this clinic. And then also to be the associate program director for the residency. And so all of these things are like super flattering, right? It was like, oh, dream job. Right? Like, this is what I'm getting to do. Because I had had that experience in my past,

I was able to come back to medicine without losing myself to it again. So it was like I was offered these jobs and I was like kind of given all of this flattery and, you know, seduction maybe, even like in academics. And I stayed for two, three years on full-time faculty. But then I realized that actually being an associate program director is sort of a middle management position. It's a lot of work. It's a lot of work. I don't like disciplining people. Like, I don't like being the one that has to, like, yell at a resident when they're not doing what they're supposed to be doing.

It was a healing journey for me, though, I'll say, like, another side note is that, like, when I was leaving the other program that I was in, like, I pretty much fled, you know, like, and I think I really was a, um, a show. of like everything that happened around leaving my first residency program, joining the cult, like all that huge mess of my life. I was like really ashamed that I was a bad person or that I was a bad doctor and coming back to medicine and like being in the leadership of a residency program and seeing like, oh no, actually I'm, I am a good doctor. Like I didn't like my mess ups were actually like very, very small in comparison to the ways that other people have like now that I was on the other side of it and sort of seeing the ways in

which trainees can sort of go off the rails. I was like, oh no, I didn't even really go off the rails. Like I just had like a little slap on the wrist and I ran away. So anyway, what I'm trying to say is that like the lesson for me. is like I came back and then I realized like, oh, wait, I don't actually want to climb up the ladder in academic medicine. I don't want to be a chair of a department. I don't want to be a program director. And I was like strong enough in myself because I had failed so profoundly before that I was okay being like, I'm going to leave. I'm going to start a private practice.

I'm going to do this social media thing. I'm going to write. I don't know where it's going to lead. I don't know what's going to happen. Yep. but I was like confident enough to just go with it. You had the courage, yeah. And you had the identity of like something,

I'm beyond, I am not here to necessarily please the system. Yeah. One thing that resonated with me a lot is you talk about how, you know, when we think about physician burnout or provider burnout, you know, it's like, oh, here's a lot. a yoga class, which you like yoga, but it's like, okay, here's a resiliency training. And I looked at this one meta analysis that showed that it was more a systems issue. Like, changing the systems actually made a bigger impact on burnout than like trying to approach the doctor, right, and change the

doctor. And I think you speak to that a lot. Like, hey, there are these systems that we're in that are leading to us feeling burned out. Like, for example, when we were residents, PGY2, it's like, yeah, if you're working 60, eight hours a week with really suicidal depressed people, like you're going to feel burned out. Like, there's no way you're not going to. Or you talk about in other YouTube's I've seen kind of like in this time of COVID, there's increased levels of stress and burnout. And with women, specifically you talk about with pregnancy, there's increased levels.

Yeah, so anything you want to say on that specifically? and just what you're seeing as kind of like, here's the problem that we're facing. So my whole kind of thesis is that this is betrayal, not burnout, that it's social betrayal, that it's the institutions that have let us down. I wrote a piece for Doximity in 2018 that's called, we don't need self-care, we need boundaries. And that was all about the fact that,

right, a mindfulness lunch hour is going to do nothing for the fact that your hospital system doesn't have adequate parental leave for people that are having babies, right? Like, you know, like, yeah, we can all, like, get access to this, like, meditation app or whatever, but, like, no, actually what we need is, like, fair pay and, like, to be compensated adequately and to have our working conditions actually be humane and, like, you know, actually have, like, office space and, like, an actual, like, desk and, you know, whatever. Like, it's like, those are Band-Aid solutions. And so the way that I've framed it, not only for women's mental health, when I'm working

with my own patients in terms of pregnancy, postpartum, and the demands on, in particular, working moms and physician moms, right, who are, you know, some of the hardest hit when it comes to juggling the mental load and the double shift. But it also just universally applies to health care workers, whatever type of health care worker you are, because you're a caregiver, and you're in a caregiving profession. And when the system that you work in is not taking care of you, it's the system that's broken. But instead, the solutions that we've been given, is like, well, no, you need to be more resilient. No, you need to just go to some, you need to go to yoga.

And it's like, well, I don't need another thing on my to-do list. Like, I already have like a completely overflowing to-do list. The last thing that I need is one more thing to do. And so the whole premise of my work has been to say, the problem lies in the system. And as us as individuals, Real wellness is about demanding change from these systems. And so then the next step is like, okay, well, then how do you actually demand change, right? So what do we actually do?

And that work is the internal work, right? Like, that's what we, essentially, that's what we go to therapy for, right? Like, we go to therapy to understand what's ours and what somebody else is, right? To learn how to set boundaries, to understand how. to change your internal narrative so that you're talking to yourself with compassion, as opposed to just constantly blaming yourself for not doing enough, for not finishing the notes, for being behind on your inbox, for not getting the, you know, responding to your voicemails. Right. It's like, no, let's stop berating ourselves and instead let's recognize I feel this way

because my employer is not treating me well and isn't supporting me. And I need more admin help. I need actual paid vacation, you know, whatever the kind of working conditions are, that's the issue. And so when you're in conversation with yourself, centering that. And then from there, that's where kind of the hardest work is of like figuring out, okay, well, then like, what is actually really important to me? Like, what are my actual real values? And that's what I was able to do like since coming back to medicine over these past six or seven years of like building the career that works for me where I like to call myself now I'm a freelance psychiatrist is what I've been saying in that you know I have a private practice I do media I have a company Gemma which is a

women's mental health platform that I founded with other psychiatrist colleagues so I'm I'm freelance I'm in control of my time I like yes that means that um I don't have a salary. I have to make my own, right? Like, make my own money for paid, but whatever. But I have the freedom to say yes and no. I get to decide what projects I take on, what patients I see, what I do.

And that was in line with my values because I'm somebody that really, really, really values autonomy. Yeah. And then from there, understanding, like, that's actually power. Like, real self-care is about getting your power back. Totally. fighting for it, right? And we have to, as healthcare providers, like, we have to fight for it because

we're just in this, like, constant grind of, like, these systems and these corporations and these administrators. I hope that you don't get hate mail for me on this episode. Oh, no, no, no, I get, I get hate mail without you saying any of this. Okay, okay, good, okay, good. No, I'm ready to get hate mail. No, no, no. No, I think, I think, like, okay, like, I'm totally wish. you and I think this is like aspirational I imagine for a lot of people but a lot of people feel stuck in the system like if you're in training if you're a medical student if you're a resident you know there are people that are gatekeepers and so I feel like my heart goes out or like even like nurse practitioners like it can or you know it can be hard when like okay I want a good supervisor

but I just can't find one you know so there's like I feel like there's these environments that a lot of my listeners are in where they're probably listening to And they're like, yeah, but how can I get there? You know, and it's just like any, any, anywhere, yeah, yeah, please. Yeah, okay, so I have two thoughts on that. So the first is to acknowledge that privilege is real and that your starting place. And when I say starting place, I mean how much money you have, whether you have a partner. So for example, my partner, who is a white male,

has a steady employed job with health insurance. So I was able to be on his health insurance and like take a pay cut to start a private practice. Right. So like there is definitely ways in which some people have an upper hand and like based on the color of your skin, your identity, what your family support system is like. So all that is true too. And I want to say that up front. The second piece is that I think there is a false illusion that it's going to be one. one decision or one answer that brings you out of that hole that you're in when the reality

is that it's actually hundreds of small little steps and you just have to find the next one. Like you don't, it's usually actually not some sort of huge dramatic thing. Like, as we talked about at the beginning of this conversation, like, it's not actually blowing up your life and moving into a commune. Like, I tried that. You don't have to do that. I did that for you already.

Like, you know, it's actually the smaller things of, like, I do agree. Like, mentorship and sponsorship is so important. And I know that you do that a ton in your work. Dave, like, I think actually, like, for me, social media was actually really, really powerful. Like, getting your voice out there and finding the other providers. in whatever fields that you're in who are also doing the same thing and who are also kind of like outside the box. Yep.

That really, really helps because you need to see, like, you kind of have to find your tribe. Like, you have to find the people who are also a little bit on the leading edge and sort of like trying out different things. The other kind of takeaway that I would have is like, yeah, if you're a med student or if you're an intern, it's going to be like really small things. It's going to be like saying like, yeah, I deserve to be able to eat breakfast in the morning. Like it, you know, it's not going to be like some sort of huge, like it's going to be like really small changes or like I'm allowed to take an extra half an hour to like, you know, read something that is fun for pleasure. So, you know.

So I have this thing that's just like at this resident or a couple of residents at a program. in the Midwest who I was meeting with and they had this attending who would call them in on the weekends to change their notes and then sometimes call them back a second time on the weekend to update it like this guy sounded some combination of narcissism and just yeah so to me what I said to them was, hey, talk to your program director as a group and come up with a strategy as a group, you know, because you guys are fearing that this guy is going to be a gatekeeper and you're not advocating for yourself with your program director. I don't think your program director would want you to come in on the weekends and change these notes. You know, you could say

to this guy, hey, I'm out of town or I'm like unavailable, but they felt completely powerless to do that, to have that conversation. Anything that you would tell this group of residents as well with your knowledge? Well, I like your advice. I think there's power in numbers, right? So always bring some, like, if you can get a group, bring a solution. Like, you know, if you as a group come together

and recognize this problem, when you go to the program director, come up with a solution for him already. So it's really easy for him to say yes. And I don't know, like, what the particular, solution is for this, whether it's like, yeah, we, he, you know, this attending can write what he wants us or like give us the notes and the feedback and we'll see it on Monday morning and we'll make

sure that by Monday at 12 noon, we have those, you know, we have the notes amended or whatever. But like, proactively coming up with the solution so that for the program director, it's really easy for him to say, yes, that makes perfect sense. So essentially it's sort of like managing up Yeah. And I think that in medicine we don't get training in that because medicine is often framed as like, it's like this calling, it's like this noble thing, you're supposed to just do everything and be there all the time

because of out of the good of your heart. Yeah. Yeah. I think it took some courage for you to jump to start your own thing. And I know a lot of providers, it's like when I talk to them, they desire that. It's just that they feel, for various reasons,

difficulty in making that jump. And you think it's, yeah, I think it's certainly easier as a mental health professional to do it because we don't have all the infrastructure overhead. But I think that's changing because there's so many, you know, there's direct primary care practice now. There's like all these other. sort of avenues, it feels like, where other specialties are sort of waking up to this understanding that as physicians and healthcare providers that we have sort of just become cogs in the wheel

and taking back some of our control and autonomy. So I think, again, like coming back to what I was saying earlier, that it's like the first step is actually like small changes. Like usually the first step is not to quit your job. Usually the first step is to start meeting the right people and like having conversations with other people and even like listening to podcasts like this, right? Listening to other people who are doing things differently. I remember when I was first, like it took me a whole year to leave full-time academics. And I started on Twitter by following a woman who is a PhD and has a podcast and a website that's called academic gig. like academia plus gig.

And she has just this whole like stash on her website of like information about people who work in academics but are like unhappy and trying to figure out like what is the next step. And she advises the same thing where it's like in the beginning in that first year or two, you don't want to leave your study paying job. You want to start to like put in seeds of like what is the next thing and figure out what it is. and only once you've kind of like done that legwork, then do you kind of like take the leap? Yeah.

Yeah. Yeah. I think I can resonate with that. Like I had started the, which I don't think I fully realize how valuable it would be, but I started the podcast like years before I left the academic gig that I had. And I moved here largely for reasons that I did not expect. If COVID wouldn't have hit,

I wouldn't have gotten up and left to Florida to, two years ago. So I thought I was going to be a lifer to tell you the truth. I thought I was going to be doing research. You know, like I had a little research team and super invested in the residents. And I still teach the residents. But I don't teach their psychotherapy groups.

That's probably the only difference. But yeah, it can be hard to venture out. and I think it takes some courage. I think it also takes knowing what, knowing your values and, like, what your unique contribution is. And, like... Yeah, speak to that.

Well, so, because I remember when I was going through this to, um, I went to, like, it was around the time when I first started writing for the New York Times and was like doing the Instagram stuff and was feeling self-conscious that I wasn't doing like real research anymore, you know? And, um,

I, had a conversation with Samantha Meltzer Brody, who is now the chair at UNC, and she's kind of like one of the foremost perinatal psychiatry researchers in the world. Like she's kind of like the top, one of the top dogs. And she said to me when we got on the phone, like I was super nervous. And she was like, Pooja, like you are doing so much for women's mental health. And I was like floored because I had thought I was like, no, like I. I'm just this little person that, like, couldn't hack it in the research world. So now I'm doing social media. And she totally reframed it for me because she was like, no, like, we need people like you. Like this is, like, we're all working towards the same goal. But it only works when each person is actually like doing what their strengths are. And my strength isn't research.

Like, I hate academic writing. And that would be a waste of me, you know? Yeah. And so it's kind of like, instead of like, holding. certain ideals shoulds. Ideals shoulds on the pedestal. Allow yourself to do stuff that actually comes more naturally to you. And I think that is also something we don't get taught that in training.

Right. In training we get taught like the best path is the ivory tower, the NIH-funded research, the lab, you know, right? Like that's the thing. Yeah. But there's so many other things that are also really important. Yeah. And to some degree, it could be seen as like breaking out of a subtle brainwashing, right? Because it's like you do have a strong culture.

There's a strong culture that is necessary to keep the institution afloat, right? To have these ideals of like this is the, this is the dominance hierarchy that you should care about, that you should, you know, to vote your life to. And so you kind of like as an independent courageous person ventured out of that to find your own journey, which is filling a niche also in the world of like, no, the world needs you to be that person that ventures out. I don't know that if I would call it courageous. I would say that it's probably more just out of like sheer like intolerance. Okay. Hey, go ahead. Go ahead. And I have like a bit of like a Bernie Sanders view on like the entire medical establishment. Like I just I do feel like there's just I think it's like a workers rights issue with medicine. Like it's just the working conditions, whether we're talking about trainees or or you know, any healthcare work. Like the working conditions are so terrible. And it's, um, there's a lot of. There's like a pyramid scheme aspect to it. Maybe we can come back and talk about that later, but I have...

Well, hey, actually, I feel like so much self-help is, like, couched in an MLM. Yeah, yeah. I remember, I remember, like, having such a vitriol towards all MLMs, and I'm sorry if you're listening to this and you're part of a good one. I imagine there could be a good one out there. But I had a friend who was venturing into this MLM, and I, like, sat him down and almost lost a friend over this. I was like pleading with him because I just saw how it can consume your life and it can give you very little reward for all the work that you put in. And I see a lot of, um, a lot of social media people are essentially promoting something like an MLM or, you know, a skincare product that it's like

they're getting paid like 60 grand to do this post or whatnot. You know, they're getting paid quite a bit of money to promote this product. And, um, I think that people are tired of that. People want more authenticity. And it's like, I think people see through that so much more now than they did maybe five years ago. I don't know. Any thoughts on that? Like just the self-help, MLM, social media, falsehood stuff that's out there.

Totally. I mean, it's all, it's a scam. It's completely a scam. It's, um, it can be really predatory. And it's essentially sort of, it's the way wellness and self-help has been commodified, right? It's all about consumerism. It's all about like buying something or selling something that is going to make you feel better when the truth and the reality is that nothing outside of you is going to fix the problems in your life. And

actually you are the only one that can fix the problems in your life. The thing that I think is actually really interesting is that it's hard for me not to see the parallels between MLM stuff and medical culture, you know, and like the conversations that I have when I'm mentoring, let's say med students who are having trouble matching, you know, and are kind of like, you know, they're on their like fourth try of like getting in. And it's just, it breaks my heart because it's just sort of like, you are in the prime of. of your life and you have sacrificed so much and you believe, like you really do believe that once you get into a residency,

that everything is going to be better when in fact, it's just going to be so much more hard work. And it's going to be a totally different type of suffering. And like the only way that you'll be happy is if you understand that, like, you're allowed to live your own life, even if you want to be a doctor. And that's like, I struggle with that because I do think that ultimately the people who go into the healthcare profession are coming from like a morally good place. You know, like most people who are coming into medicine are doing it because they really do want to serve.

but there's a way that this system just is so masochistic. And because it's so masochistic, it sets you up to think that once you get to the top of the MLM pyramid, that then you'll have arrived and then you can be a whole full person. But very few actually get that, right? Because most are actually saddled with hundreds and thousands of dollars of medical debt. Um, it's like the last thing I'll say on this. It's funny because, um, you know, my parents have a lot of Indian friends who, a family friends who want, you know, they all want their kids to go to like those six year training programs where you do, you, you know, do a short college and then go to. And so they would sometimes call me to ask for advice. Like, hey, Pooja, like, what do you think I should do to get it? And I would just start telling everyone, no, like don't. Why would you skip two years of college? Like, those are the best years of your life. Like, no. go to four years of college and then if you still want to be a doctor, go to med school. And then people stopped calling me. The aunties and uncles were like, don't talk to Puja, no.

Something's going on with Fuji. Like, well, because I was just like, why are we so addicted to suffering? Like, why can't we just let ourselves? And it's because of the system, right, that has trained us to believe that if you give every ounce of yourself, then sometime in the future, you'll get it back. But that's not true. It's only true if you make it happen.

So I think that's like what I want. That's what I really want, like folks that are in medicine to like really meditate on and think on. And again, like what you were saying, like there's going to be people like might be listening to this that are like, I'm a resident. I just have to do the hours that my program tells me, you know, like I am beholden to this institution.

I don't have a say. And probably 90% of that is true. But there's probably 5% to 10% that you can figure out that you have some places where you can exert some agency. I don't know exactly what it is, but that's the question to sort of reflect on. Yeah. I think a lot of the medical students' residents that I meet,

their most stressful things are interoperational. things with supervisors or bad mentors or jaded, you know, like people in the establishment who are just, you know, controlling them excessively. And I try to help them refocus on like, okay, what brought you into medicine? It's to help people. That's a good desire. You can find meaning in that. I think what you're balancing that with as well is you can also find meaning in taking care of your own self and not feel guilty about that. I think guilt, like how do you overcome guilt in the perfectionism, sort of striving of medicine, right? Yeah.

And the guilt. So it's like I could say look for the meaning with the patients, but that could actually inspire more guilt. Well, I don't find it meaningful anymore because I'm so burned out. Yeah. I talk about guilt as a faulty check engine light. Like it's like a blinking light in your car where you know that everything's fine with the engine, but the light just keeps going. Like, it doesn't actually provide any meaningful information.

If you're a med student, you probably feel guilty all the time. Anytime you do something that's not studying, you feel so guilty, right? And so it's like, that's not a very helpful moral compass, you know? Like, what is that? That's not productive. The first time that I went to therapy, my chief complaint to the therapist that I was that I didn't have any hobbies. Like, I didn't know what to do if I wasn't studying.

My partner would now probably argue that I still don't know what to do if I'm not working. Okay. But that's a same thing. You know. Now you're doing, you're still working. You're just working in a different way. I'm still working on the things that I really find meaningful. Yeah.

But so I guess, like, finding meaning, you're allowed to find meaning as a med student. I would also say maybe it's like thinking deeply on like, it's okay for your training to be a means to an end. Like, it's okay to. Right. To see it as like, okay, like, I'm going to have to jump through these hoops to get to where I want to go. And that's okay. Yes. Yes.

And like I, and let me really actually dream. Yep. And consider where I want to go. And like the place that I want to go doesn't have to. to be the place that everybody else is telling me that I'm supposed to go. So that could even be in the context of like, I have lots of, I get DMs sometimes from people that are like in psychiatry, like people that are like, I felt, I felt like I shouldn't be a psychiatrist, right?

Like my parents wanted me to be a surgeon. My parents wanted me to be a pediatrician and, right, like that type of thing. So even in choosing what type of doctor you become or what kind of provider you become, like allowing yourself to like actually be the person who chooses that like that's another form of agency right yep there's like an ideal like i should like my ideal was like initially orthopedic surgeon and but the more i did it i was just bored and so yeah i had to go through that where i was like well but kind of the you know i remember telling a trauma surgeon like he was talking to me about what i should do and he's like you should be a trauma surgeon whatever you don't be a psychiatrist psychiatrist, you know? Right. And I was like in the back of my head like, yeah, I'm like this, you know, this is the ideal, right? This is like everyone has an ideal and it's like, how do you find your own path in that and not like be able to block out enough of the voices, the external voices, the shoulds, the guilt, right? Yeah. I imagine your therapy was really helpful for that.

It was so helpful. It was psychoanalysis is something that, you know, I know it's like I sometimes feel self-conscious about talking about it because I know it's such a privileged. It's so privileged to be able to have the time in your life to be able to do it. And the reason that I was was a bunch of things. One, I found an analyst that would see me for sliding scale. So she reduced her fee for me to, I had health insurance that reimbursed it. most of it. And then three, her office was located just three blocks from GW. So I could walk

in between patients. And you know, the thing that I would say, because, you know, like, Solomon Aqtar told me, like, the reason I went to Sierra was like, Pooja, you need to go into analysis. And like, when Sullivan Oktar tells you to do something, you're like, okay, of course. Right. And I had this, like, fantasized notion that, like, analysis would, like, turn me into some sort of magical, shiny person. And it didn't. It didn't. Actually, I don't think I'm, I don't think any of the choices that I made in the past

seven to eight years are different. I just understood them so much more. Like, I understood what my choices were and why I was making them, whether it was leaving full-time academics, whether it was like deciding to move to Texas with my partner and getting more serious with him, like deciding to be a mom. Like, all these things were like, here. huge life decisions that I had the space to actually, like, come to them on my own with my analyst who I just, I love her. She's, she's amazing. And I can't believe she's retiring.

So hopefully I don't fall off the rails without her. We'll see. Yeah. It's frustrating to have, yeah, maybe she can, like, keep you as a patient or like, Just once a week in your retirement. We talked about that. We talked about that. Just once a week. Let's go down to once a week. If you want to take a vacation, I'll be okay.

Right, right. My mentor, Dr. Tari, is like 96 or 97. And like, he still sees some clients. So, you know, maybe she can see someone. There's hope. There's hope. Yeah. Yeah.

Wow. Okay. So I feel like we've covered so much. Is there any other big categories you definitely wanted to get to in terms of like, let's say, let's just narrow it down to providers doing their own, you know, self-help journey, their own self-care journey? Like, anything that's still like lingering in your mind that you would definitely want to put out there to them? I think the only thing that I would say is that it's, like, healthcare professional,

Like, you guys are my people, right? Like, I've lived this so deeply. And, like, the lesson, like, the sound bite that comes out of it is that the real self-care is in your decisions. Like, it's the choices that you make for your life. And I just want everybody to know that, like, you do have choices. Even despite being constantly surrounded by all of these systems, like, I think health care workers are some of the most overburdened and most time poor. right? And so it's like you have to be the one to claw back that time. And then once you have it, like that's where you figure out like, like this is my one life. Like I get to decide and I'm allowed to

decide. You know, I just want people to like keep that voice in their head and like, you know, keep coming back to these types of communities like, you know, whether it's yours or mine or like the other There's lots of these communities of like mental health professionals like us that are having these conversations and coming to it from a coming to it from a place where we're not we're not trying to sell you like a skincare product. No. No. By the way, do you have any conflicts of interest to report?

Right. Well, I do. I saw the form that you sent me and I didn't. I didn't fill it out yet. So I do have a company. It's called Gemma. And it's a women's mental health education platform. Okay. That's not a conflict of interest because it's for providers and it's an education platform. So it's not considered a conflict. Okay. Okay. The, what I was thinking was, oh, you would be proud of me. So I got so busy. I was working from like eight to five every day, five days a week without considering any of the podcast or social media or anything, right? So I was just, just patience. And so at the beginning of this year, I was like,

and then I would try to like, I'm going to block out like Wednesday from like 8 till 12 and that's like I'm just going to keep that no patient cares and then patients would kind of like leak in you know like I really need to see you which I like I love seeing patients so like it would just fill up right

but finally this year I was like I'm going to block off Thursdays and see no patients right awesome occasionally a doctor slips in who can only see me on Thursday but by and large it's like no patience Thursday. So I have at least one day where I'm like balance. I don't know. I'm very proud of you.

I don't know. Maybe that's not good enough. I think that's great. It's great. Yeah. Hey, this is awesome. We're going to have to have a part two because I feel like we're barely scratching the surface of so many things that we could talk about, like women's mental health, you know, your approach to postpartum depression, postpartum anxiety. So if you're in the audience and you want to hear more, let me know, shoot me an email questions that you would ask next time. And I'll have you back. So thank you so much for coming on. It was such a pleasure to be here. I'm super excited to come back. I'm already ready for conversation number two. And for folks that are listening, you can find me on Instagram at

Pooja Lakshman, and then my company, Jemma, is jamawomen.com, G-E-M-M-A women. And you can get my book, too. So thank you. I'll put those all in the show notes, those three things, and in the article that goes with this as well. So thank you.