The One You Feed - The 4 Principles of Real Self Care with Dr. Pooja Lakshmin

Episode Date: January 9, 2024

Dr. Pooja Lakshmin, a psychiatrist, shares her journey of discovering the true essence of self-care. Drawing from her experiences with patients feeling overwhelmed by the wellness industry’s commodified approach, she unravels the concept of “faux self-care.” Pooja articulates the four principles of real self-care and the ever-changing nature of this internal process. In this episode, you will be able to: Define and discover the transformative power of real self-care Learn to set healthy boundaries for genuine self-care Overcome the societal challenges to prioritize your self-care Explore the intersection of self-care and activism for personal and social change Embrace the importance of values in nurturing authentic self-care practices To learn more, click here!See omnystudio.com/listener for privacy information.

in some kind of spiritual movements or wellness movements, we tend to kind of exalt the person who has overcome the obstacle and forget that there's going to be more obstacles. Welcome to The One You Feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like, garbage in, garbage out, or you are what you think ring true. And yet, for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit.

But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf. Wolf. We all know that good habits are ways that we bring what we value into the world, and we each have our own list of what matters to us. Maybe you want to feel more energetic, improve your relationships, have a tidier home, cook more instead of eating out four nights a week. Whatever habit you want to build, it's entirely possible to make it happen. But if you feel under-equipped and overwhelmed to make real sustainable change, you are not alone. And that's why I've made my free master class open to everyone and available to watch anytime now. It's called Habits That Stick,

How to Be Remarkably Consistent No Matter What Goal You Set. You can grab it at oneufeed.net slash habits. Again, it's free and you can watch it whenever it works for you. Go to oneufeed.net slash habits. I'm Jason Alexander. And I'm Peter Tilden. And together our mission on the Really Know Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer.

Go to reallyknowreally.com and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. The Really Know Really podcast. Follow us on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. Thanks for joining us. Our guest on this episode is Dr. Pooja Lakshman, a board certified psychiatrist and author specializing in women's health and clinical assistant professor of psychiatry at George Washington University. She's a leading voice

at the intersection of mental health and gender, focused on helping women and other marginalized communities escape the tyranny of faux self-care. She maintains an active private practice where she treats women struggling with burnout, perfectionism, disillusionment, as well as clinical conditions like depression and anxiety. Pooja is a frequent contributor to the New York Times and often goes viral on Instagram. Today, Eric and Pooja discuss her book, Real Self-Care, a transformative program for redefining wellness, crystals, cleanses, and bubble baths not included. Hi, Pooja. Welcome to the show. Hi, Eric. Thank you so much for having me.

Yeah, I'm really excited to have you on. We're going to be discussing your book, Real Self-Care, a transformative program for redefining wellness. And in parentheses, crystals, cleanses, and bubble baths not included. So we'll be talking about that. And I think there's so much great material in there. But before we get there, we'll start like we always do with the parable. In the parable, there's a grandparent who's talking with their grandchild. And they say, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love. And the other is a bad wolf, which represents things like greed and hatred and fear.

And the grandchild stops, think about it for a second, and look up at their grandparent. And they say, well, which one wins? And the grandparent says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. I love the parable.

I think that it applies in so many different contexts. And as a psychiatrist, one of the ways that it speaks to me is that it calls our attention to our internal worlds and it calls our attention to the agency that we have. There is so much, obviously, that's out of our control given the socio-political context that we live in and global events that are kind of always taking place and our internal worlds. and global events that are kind of always taking place, and our internal worlds, we get to decide what we give our attention to, internally and externally. And the parable to me is really, that's what it's about, that you can exert choice, you can exert agency. And in doing

that, it's kind of radical, right? And sort of even recognizing that it's powerful. radical, right? And sort of even recognizing that it's powerful. I love the way you frame that up. And I'd love to start by heading into talking about real self-care. What's the difference between real self-care and what you call faux self-care? I wanted to set up this framework in a way that called to attention the wellness industry, for starters. And that's why, you know, one of the subtitles, crystals, cleanses, and bubble baths not included. Because in my practice, I see patients come in all the time and they say, you know, Dr. Luxman, I'm stressed out, I'm burnt out, I'm not sleeping well, I'm not eating well. And I feel like it's my fault because I have this

meditation app on my phone that I know I'm supposed to be using. But by the end of the day, the last thing I want to do is meditate. And I've said over and over what you can buy, it really takes away from the true meaning of well-being. So when I say faux self-care, what I mean is it's the juice cleanse. It's the bubble bath. It is also the yoga or the meditation. And I know that there's folks that are listening that are like, hey, wait a second, Pooja. Yoga really works. Meditation really helps me. And I'm not saying that they're bad. What I'm saying is that the actual real self-care is the internal process that you take to get to the thing. So you can imagine one person is at a yoga class and they're on their mat, totally in their head, comparing themselves to the person next to them that's doing a headstand and they can't do a

headstand and maybe they're not wearing the right Lululemon leggings and that's their yoga class versus somebody else who's gone through the principles of real self-care, set boundaries, understood how to apply self-compassion to that inner critic in their head, really understood their values and why yoga is so important and what it means for them to be at yoga once or twice a week and how that is actually an exertion of power. That person is actually fully present in the yoga class and able to really kind of take it in. But on the surface, both of those are, I went to a yoga class. That's what I'm kind of trying to explain here. And I will say it is a little bit abstract.

You know, the principles of real self-care, there's four principles, boundaries, compassion, values, power. They're all internal, right? Part of the framework too is that I can't actually tell you what your real self-care is, like what your tool is. You have to work through the principles yourself because it's different for everybody, right? For one person, it might be yoga. For another person that week, it might be, I'm going to actually go out to dinner with my close friend. For another person, it might be actually what I'm really avoiding is doing my

taxes. I need to sit down and do my taxes, right? So it's always changing as well. and I need to sit down and do my taxes, right? So it's always changing as well. Yeah, yeah. And I've heard you talk about this in a sense of, you know, real self-care is a principle or a set of principles, not tools. Now there are tools that we can use and I think your yoga class example is a great one.

You know, the obvious one being a hammer, right? A hammer could drive in a nail. I could also smash 10 windows with it if I wanted, right? Like the tool is sort of only as effective as the way in which it's used and the circumstances in which it's used and why it is used. And I think that's what you're kind of aiming at is this deeper internal sense of what really matters to me. And am I living my life that way? I mean, to me, that's the foundation of any kind of good life. You know, it's not even just self-care. It's just a good life is about knowing what matters to us and aligning ourselves with that. And the situations,

the power structures that we find ourselves in often make that very difficult to do. Yeah, I completely agree with you, Eric. And I think that it all comes back down to values. And we can talk a little bit about what values means and kind of how to get there. But like you said, it's actually hard. It's actually radical because so much of our external world and the way that we live our lives in this kind of very productivity oriented culture is actually pushing against that is pushing you against your own unique sort of preferences and quirks and things that actually bring you joy and are telling you, well, no, actually, you know, you should just, I have an example in the book of a patient who was

redoing her kitchen and was like, you know, everyone's telling me to like get beige, right? Beige, everything, because that's the resale value. And then she's like, I hate beige. I hate beige, you know? You know, that's kind of, it seems like a silly example, but it's actually, those are the types of decisions that can be really empowering. I think about these ideas a lot.

What does it actually mean to be well and how do people become well and how do they heal, you know, with my own addiction recovery and depression recovery. And, you know, there's an idea that I talk about often. It's not my idea. It comes from the Buddhist concept of refuge, right? Refuge being a place that you go when things are difficult. And we'll talk about true and false refuges, right? And that is like, you know, a false refuge is maybe zoning out all the time to Netflix versus engaging in your life. A true refuge might be something like more like yoga or meditation or, but you're talking about an even deeper level than that, right? Like it's one thing to move, to spend less of our time on the

false refuges is the things that don't actually rejuvenate us, refresh us, make us feel better and spend more on things that do. But you're talking about an even deeper level where we're making really difficult decisions about how and where we spend our time. And that can be really difficult to do. My experience is that's really difficult for people to do when they're already overwhelmed. So let's talk a little bit about, you know, the person who's like, I'm already drowning. How do I start to implement deeper principle-based things which seem like they are going to take a lot more time and energy? How do you approach that with someone? Yeah. And I really appreciate you bringing that up because it's true that so many folks really kind of feel like they're in that drowning place. And I will be totally honest. I have a little kid, a toddler. I have a demanding career based on the idea of the concept of eudaimonic well-being, which is probably not new to you or to your listeners. But just as a recap, eudaimonic well-being says that a well-lived life is one in which your activities and your behaviors are aligned with what's most important to you,

with your purpose. And there's tons of research out there that shows that folks who are able to identify and name their values and their purpose and feel that their life is, for the most part, aligned with those things. Not 100% because no one's perfect, but mostly in that direction. They have better mental health outcomes. They have better physical health outcomes. And this is in contrast to hedonic well-being. Hedonic well-being, you can kind of think of it as the pursuit of pleasure or the absence of suffering. That's kind of like the treat yourself sort of mentality, which I think that's what we're kind of referencing a little bit too. Because when you're drowning, you just kind of feel like, well, you know what? I just need to get that 600 calorie Starbucks latte. That's actually a

milkshake because I deserve it, right? I just need to escape. I need to watch six hours of Netflix, right? So the reason that the first principle of real self-care is boundaries is because you can't even actually get to the values part until you start to make some space for yourself and you start to energetically really consider what it means to take up space and how to sort of take some stuff off of your plate. and how to sort of take some stuff off of your plate. The boundaries piece is probably the hardest piece to this whole process. And that's the reason that it's the first one. And it's also the reason that the four principles are sort of, it's a circular process. It's not just like linear.

It's like, you're always kind of basically coming back to boundaries because if there was one mental health skill to learn, boundaries is the one. And to get back to your question of like how to actually do it. So folks might be kind of rolling their eyes a little bit because I will acknowledge that, you know, basically every therapist on Instagram is talking about boundaries at this point. So it could be a little bit sort of cliche, but my take on boundaries is a little bit different. So I think of boundaries as the pause,

not saying no, but it's the pause that is the boundary. And this was kind of an aha moment for me back in 2016 when I had just graduated residency from George Washington University. My mentor took me out for lunch and it was my first day on the faculty and I was like bright eyed and bushy tailed. And she was like, Pooja, I have one piece of advice for you. And I thought it was going to be some sort of like clinical pearl about how to dose SSRIs or like mood stabilizers or something. And she was like, no, Pooja, you don't need to answer your phone. You can let it go to voicemail, listen to what they want, decide, and then respond. And that's when I was like, oh, it's the pause. And then you can choose yes, no, or negotiate. Because the

truth is there is always a cost to know. And that cost might be financial, it might be emotional, interpersonal, but we can't pretend that no is accessible to everyone all the time. Right. Right. That pause is so important. I had a coaching client once where, you know, we had to set up a new rule. And the rule was that anytime anybody asked them to do anything, they had to say, that's a really interesting opportunity. Let me get back to you. Even if inside they were screaming, yes, yes, yes, yes. I want to do it. The answer was always for this person. Thanks for the invitation to do that. Let me think about it because part of what happens, Thanks for the invitation to do that. Let me think about it. Because part of what happens, and I know I do this, is I get asked to do something and I evaluate that thing on its own individual merit. I'm like, oh, that does sound really cool. And I'll say yes. But does it sound cool when I consider it in the context of everything else that's going on in my life. I need a pause to be able to do that. And this person, we just found that was the rule we had to set so that they could come back and go, all right, let me have a few minutes

to actually think about this. When is it? What else is going on that week? That sort of thing. So I think that pause is so critical. And I love the idea that a boundary isn't always no, right? That a boundary could be yes, could be no, could be negotiate, but that the critical thing is taking the time to contemplate the decision. Yes. Yeah. And, and, you know, it's funny, this isn't my therapy session. I have my own therapist too, but, but I'm totally going through that right now with writing a book and all of the influx of demands that have come and opportunities in this new kind of phase of my career where I really love seeing patients. I love working with people one-on-one. I also

love writing. And now all of a sudden, my weeks, I don't have time to write anymore. And so I'm going through my own round of real self-care where I'm like, hey, wait, what happened here? How do I get back to the things I actually really enjoy? I do enjoy these conversations too, for sure. But it's like you have to really be selective and understand, like you said, the context. And I share that story and my own personal experience because I think it's important for folks to understand that this is always a work in progress. And with every new season of your life, whether it's a new, whether it's a promotion you get, whether it's, you know, a new baby, whether it's going through divorce or illness,

you're going to have to relearn the skillset because it's, again, it's a new context. You don't know yet what all of the data points are. So it doesn't mean that you failed. It doesn't mean that you don't know how to set boundaries. It just means that you're just developing the same muscle in a new context. Yeah, absolutely. So I would love to maybe for a moment go back to a little bit on the faux self-care side. I wonder if you could share with me what you mean when you use the phrase, the tyranny of self-care. Yeah, that came to me actually in the context of my experience as a healthcare worker, as a physician. So as many folks know, whatever side of healthcare you're on,

whether it's the clinician provider side or the patient side, healthcare in America is broken. And especially mental health services. It's so hard to find affordable, accessible care. And so what I was seeing, I mean, even starting to meditate, you know, resilience training, you know, here's your yoga class. But it was like, they weren't doing anything to actually fix the structural issues. So making sure that there's like adequate paid leave, making sure that people can have, you know, a certain number of sick days, all of those kind of systemic supports were not there. And instead, they were putting the onus on the individual to meditate or to do yoga or to lose weight or whatever the thing might be. And so that's what I mean when I'm pointing to the tyranny. It's another way that greedy capitalism, I just came to learn that term, greedy capitalism

exonerates the system and puts the onus of responsibility on the individual. And then you feel bad because, you know, like I was saying earlier with like the meditation app where you go through your whole day and you're working like triple shifts, but then you feel like, oh, well, if only I took the time to meditate, I'd be able to fix all these problems. And that's not to say that meditation or any of these individual choices, it's not that we don't have agency. We certainly do. But I think, you know, I come from a framework of the dialectic. It's both and, right? We need both the systemic change and systemic change. Because this, I think, is a concept I find really interesting to think about and often difficult to put into practice, right? Because on one hand, we recognize that the individual solutions are not sufficient.

And yet, we can't snap our fingers and have the world be different than it is right systemic. And I'll be honest, I lean towards the individual because that's where I feel like I have the most to offer. And yet there is the systemic side. And what I have seen happen in a lot of what I would consider the wellness movement, the self-care movement, is this idea of it becomes very individualized and it can become very self-absorbed and where all my energy is going into, I'm going to get better. And then it's often talked about like, once I'm better, then I can contribute to the world. And I think that's a false choice because that often doesn't come. I mean, my first introduction to wellness and healing and all that in any real way was a 12-step program.

And right from day one, we were encouraged to be helping other people, right? Working on the collective whole and ourselves were joined together. And I'm just curious how you think about that, you know, the individual versus the collective or the systemic change. And I think the way you do think about it is different than a lot of ways I've heard it articulated. So I'd love to get your thoughts on that. It was a long question. I love long questions. I appreciate you saying that you lean more towards the individual side because I hold that bias too. I'm a psychiatrist. I work with people one-on-one and that's where I feel like I can be the most helpful as well. And part of what, like my own real self-care process,

like part of what rejuvenates me is using my voice to advocate for the structural changes and for my patients and, you know, kind of hopefully moving the conversation to a different place. So I did, I actually had a conversation a few months ago for the Ezra Klein show with Tressie McMillan-Cottom, who's a sociologist and an amazing powerhouse. She's a sociologist. So she comes from the complete other side. And I was a little nervous because I was like, oh gosh, I'm going to have to really prove to her, you know, because the reality is the examples that I give in the book of, let's say a woman who, a patient who is, you know, going through the boundaries, the compassion, the values, and works up the strength to have a hard conversation with her partner about the fact

that after having, you know, two kids for the third, she really wants him to ask for having a paternity leave. And that leads to him asking and his company saying yes. And that change goes on to impact everybody else. That's rare. A lot of employers would say no. And that's true that this isn't every situation or every circumstance. But my take on this is that if wellness and self-care stays commercial, if it stays commodified, then we don't even have a chance of getting to collective change. Whereas if we start conversing about self-care as an internal process, as a personal process, then at least we have a chance of getting to that collective change. I think of this as the dialectic that we discuss, which isn't my concept. That comes from dialectical

behavior therapy, Marsha Linehan's work of being able to hold two opposing truths at the same time. And I think that change is always so much slower than we want it to be. One of the things that gives me hope and that helps me stay in the fight, really, because I think that's what it is, right? Staying in the fight and continuing to have these conversations and reflect and think about your choices is I'm actually the first generation of women on my mom's maternal side to go to graduate school, to get a doctorate, to work professionally outside the home. That's just one generation. And those types of changes, that's a big deal. That's a big deal. And yes, it takes a long time. But I think that probably most listeners can look back at their family tree,

their family history, and see in one or two generations how much has changed and how much is different collectively. Yeah, I think being able to hold the opposites there is really important in this area because it's both at the same time, the little things that we do, like you being the first person in your family to do X, Y, and Z is like a really big deal. And progress is being made. I mean, I can't help but look around at certain aspects of society and be like, wow, the progress is tremendous. And there's a long way to go. Like I often think about like gay rights, right? Gay rights from when I was an 18 year old to where they are today is a night and day proposition difference. It is an order of magnitude difference. And at the exact same time, there is some gay child being bullied somewhere

in some small town in Missouri, right? Both those things are true. We've made a ton of progress and we've got a long way to go. But I feel like it's so important to grasp both Both those things are true. We've made a ton of progress and we've got a long way to go, but I feel like it's so important to grasp both of those things because at least for me, if I don't acknowledge and see the progress, it doesn't give me much hope to continue to try and do things differently. But if all I do is get into a Pollyanna, everything has gotten better phase, then I'm not continuing to advocate for changes that need to occur. better phase, then I'm not continuing to advocate for changes that need to occur. Yeah, I completely agree. And I was just thinking back to an experience that I had at Esalen. I mean,

I write about this in the book, actually. I went to Esalen. It was in, I think it was like 2018, and I was burnt out as a psychiatrist. I went very seriously. I was going to get these deep questions answered. It was like this mindful movement week and it was a lot of money. You know, it was expensive. Esalen is not cheap. And I remember when I was there, there was this couple, they were in their 60s, I think, and we were eating lunch together and they're like, oh yeah, we come here once a year for our vacation. We're here on vacation. And I was so insulted. I was like, this isn't a vacation. You know, this is serious work. like, this isn't a vacation. This is serious work. And this was after Trump had been elected. As I reflected more on this, I think they were more right than I was in terms of thinking about it actually as a vacation, as a refuge, as a way to get away. It was probably more accurate than

the pressure that I was putting on myself for that week of time. And one of the things that stuck out to me while I was there is that nobody was actually talking about Trump there. It was totally this internal, spiritual, woo-woo place. A lot of wealthy white folks, right? And the absence of any of that discussion about social determinants of health, about identity and race and privilege, it was glaring. So I think even actually just bringing it into the room, just bringing it into the room and like having it be part of the conversation in the wellness space, that in itself is powerful. Like we all know that change takes a long time and it's hard. And I don't think anyone's expecting, you know, their meditation teacher to be able to solve, you know, the mortgage crisis,

right? No one has that expectation, right? But at least to be aware and to bring that into your framework of how you're teaching and how you're presenting information, I think goes a really long way. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer. Will space junk block your cell signal?

The astronaut who almost drowned during a floor? We got the answer. Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you and the one bringing back the woolly mammoth. Plus, does Tom Cruise really do his own stunts? His stuntman reveals the answer. And you never

know who's going to drop by. Mr. Brian Cranston is with us today. How are you, too? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really No Really, sir. Bless you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really No

Really. Yeah, really. No really. Go to reallynoreally.com and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. It's called Really No Really and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. I had a conversation recently with Padraig Otama, I never know how to say his name. He's a poet. He runs a podcast with the On Being Network called On Poetry.

And he had a section, and we got into this conversation, and I'd never thought of it this way. But I think it ties a little bit into what you're saying, which is he talks about in any sort of church movement or an AA movement or anything, there's a lot put on the testimony, meaning somebody saying like, I was this broken person and I did this, or I was having a lot of problems with depression and then I took ketamine and suddenly I'm better, or I meditate and it makes me feel X, Y, or Z. And those are useful things. But what happens for the people who are sitting there who that's not happening for? For the person who is the meditation teacher is going on and on about how much meditation has changed their life or one of their students is talking about and somebody else is sitting

there going, well, I meditate 20 minutes every day and my life is still a mess. Like, what about that? So like, what does that do to people? And I think it ties to what you were just saying. If we're not talking about the social determinants of wellness, if we're not taking into consideration the context of which people's lives are, these ideas can actually become, and I think this is what you're talking about with the tyranny of self-care, these ideas can become ways that we feel worse about ourselves or cause us to disengage from potentially helpful modalities at all

because we feel like we're not being understood by them. Yeah, that's such a great point. And it's interesting, as you were talking, I was also thinking my mind went to the person giving the testimony. And what happens to that person when, understandablyably something traumatic happens in their life, right? And they stop meditating or maybe they are still meditating, but it doesn't work like it used to. And then where do you go from there? And I think for me, that's why with real self-care, it was so important to frame it as it's not an outcome. It's not a destination.

It's a continuous process. And I think you could probably say the same about whether you call it activism or organizing or whatever term you use for moving our society to a more progressive place. I think just because of the nature of how deeply inequitable our society is and then the roots on which we were built, I don't think it's a destination. I think it's like we just always have to keep going. And it's kind of an, in some sense, it's a little aspirational. So to me, progress is actually staying in it, right? is actually staying in it, right?

Like staying in the game and like continuing to come back to that work, even when you have moments of burning out, even when you have times where you're like, you know what? Yes, I did just order something on Amazon, even though I know I should be supporting the small businesses down the street. And right, like not beating yourself up too much

and just being like, okay, well next week, you know, I try again. That's I think how we have to think about success. And in my mind, I think there's a connection there with the testimony and the way in which in some kind of spiritual movements or wellness movements, we tend to kind of exalt the person who has overcome the obstacle. Yes. And forget that there's going to be more obstacles. Yeah, my life is a testament to that, right? I mean, like, you know, I got sober at 24 from heroin addiction, you know, stayed sober

eight years, then started drinking again. So it was like, what now? Like, all that's out the window. And then, you know, get sober again and depression. And you probably run into this a little bit, too. I think one of the other elements that gets into this, if you're the sort of person who helps others to any degree, you suddenly are worried about when you're not doing great. Like, is everything I teach people BS? Yep. Yep. Right. You know, I've evolved with that over the years where I'm like, well, no, of course it's not, you know, because I'm just a human and

I have difficult times and I cope with those difficult times way better than I used to. It doesn't mean I cope with them perfectly. You know, it doesn't mean that I don't make mistakes. It doesn't mean that I don't do all that stuff, but I do it a little bit better than I used to. But, you know, 10 years ago when we started this show, I can't remember the exact phrase, but I wrote out a little introduction for the show. And listeners can probably tell you exactly what it is because it plays at the beginning of every episode. I just don't listen to it. But it was something along the lines of living a good life takes consistent, creative, and constant effort. Meaning like this never ends. You know, it's not like you're going to just

listen to just the right conversation on a podcast or go to just the right weekend, you know, retreat or week long retreat, and then it's over, you know, retreat or week-long retreat, and then it's over, you know, and you're suddenly well for good. Like, that's not how life works. Yeah. Yeah. I'm just nodding my head because I just agree so vibrantly. And I hate that we live in a culture that like exalts or, you know, kind of puts on the pedestal that it's better for it to just be neatly tied into a bow, you know, kind of because I think pedestal that it's better for it to just be neatly tied into a bow, you know, kind of, because I think it's so much more interesting to, you know, I would say people, I do therapy with my patients as well as prescribed medications. And that's relatively

unusual for a psychiatrist. But I say it's because like therapy is so much more fun for me. Writing prescriptions, like that's fine. That's like, you know, that's, but the therapy piece is like getting to be with somebody on their journey. Like that is, that's just such an honor. And I, I gained so much from that too, in terms of just the privilege of being there. And what did I want to say? You know, I share in the book, in the introduction, my own kind of tumultuous history, which about a decade ago, more than a decade ago at this time, I left medicine, blew up my marriage, moved into a wellness commune that was focused on sexuality and spirituality and meditation. And I was with that group for two years and then ultimately left

and had to kind of rebuild my life and come back to medicine. And part of what led me there was the false belief that there's just like one answer and that there's just like this one thing that will fix everything. And also the belief that it's outside of you, that somebody else knows, whether it's, you know, the meditation teacher, the podcast host, the psychiatrist, right? Like it really isn't, unfortunately. Like the reality is for real wellbeing, it's something that you have to work at every single day for the rest of your life. And ultimately it does have to come from you. And that's, you know, and then maybe that's depressing, but I think that's hopeful actually, because that gives you back the agency.

Yeah. I was going to say it on one glance, it can feel overwhelming, particularly if you're in a very difficult spot and you're like, it's always going to feel like this. No, I don't think that's what we're saying. I think we're saying that there's no destination. I think it's absolutely true. And I think part of the problem, too, is the way that wellness has become commoditized and commercial. And I'm part of that, right? Like I have a podcast and we get advertising in order to run the podcast. I teach courses, right? And I have to market those courses, right? And I'm always really struggling with like the sort of marketing that will actually entice somebody into doing the course versus going over the top. Or, you know, I've often said like you could boil

my entire philosophy down to like, I will teach you how to not make things worse. I'm like, that just doesn't sell. Like nobody's going to buy that. It's a tremendously useful skill, actually, if you have it, right? You know, but I wrestle with this in my own way. And I mean, you know, anybody who writes a book, right? you've got, you're getting blurbs on the book that are just over the top, right? They're just like, you know, we want those blurbs because that's what's going to sell the book. And I just find it, it's a complicated relationship to have to be both critiquing that space and be in it. Yeah. Yeah. It feels like you've been in my brain for the past year. So as I launch a self-help book and, but you know what I would say is that the way that I handle this is to be

transparent, you know, and to acknowledge like that I do wrestle with it and that I do not to pretend that it's not there, those contradictions, but to really bring it into the room. And I think that humanizes the quote unquote experts. I think that it also gives people who are looking for a structure, right? Because we can't give answers, but we can provide a structure, right? People that are looking for a structure, it helps them to be as they're choosing sort of what they put in their ears. Right. Yeah. Who's on their feed when they're scrolling. You know, as a physician, I think that I've come to the where I've landed is that when when doctors are not in these spaces, then the void gets filled with a lot of junk. And so it is actually important for folks who are coming with integrity and do have training and background and knowledge to, I guess, do the messy work of figuring out how to be there as opposed to kind of staying up on this high horse and kind of being like, well, that's beneath me.

to kind of staying up on this like high horse and kind of being like, wow, that's beneath me, you know? Yeah. Let's get into the principles a little bit more and maybe we can, you know, give some tools for people to use. Again, real self-care is not about a tool, but some practices and different things. And so I'd love to just have you sort of reiterate, you know, the four principles of self-care again. Let's go into those a little more deep. Yeah. So there's four. Boundaries, compassion, values, and power. You could kind of distill it down to, because I know everyone likes, you know, just a list. Do less things. Be nice to yourself. Spend your time on what really matters. That's the hardest one. And either give back or ask for help. And, you know, we talked a little bit about boundaries and how my conceptual boundaries

is the pause, right? And you can think of that on the micro level, you know, when an email comes in from your boss or your kid's school asks for you to join a committee. Or you can also think of it on the macro level of like, you know, what do I want my career to be? Where do I want to live? Do I want to have children or not? Like those are big, big life decisions that you can take a pause or you should take a pause. You shouldn't just kind of continue on the path of what you think you're supposed to have your life look like and then end up doing what I did, which I would not advise blowing it up. Right. So there's kind of two levels to that. Compassion is the next principle because obviously as soon as you start setting limits with people in your life, everyone's going to be mad at you and have feelings and then you're going to feel guilty. And so because in my clinical practice, I work

with women, mostly mothers, pregnant and postpartum folks, you know, the number one complaint I get is sort of like, okay, Dr. Lakshman, I'm saying no, I'm setting boundaries, but like, I feel so guilty. I feel so guilty, you know? And the way that I work with this comes from acceptance and commitment therapy act. It takes a lot from Buddhist philosophy, which is like, you know, yeah, you feel guilty. Like, yes, we can't change our feelings. That's not how feelings work. It doesn't work to try and run away from the guilt or to turn the guilt off. And so I think of guilt as actually a manifestation of all of these external social constructs and contradictory expectations that are put in particular on women, but not only women, because I know men experience this in

different ways too. But when you're told that you have to be in two places at once in order to be a good mom, like that doesn't make sense. You can't do that. There's no right choice. And so our brain takes that conflict and makes us the bad guy. And that's guilt. So one helpful kind of metaphor that I use is to think of guilt as if it's a broken check engine light on your car dashboard.

So, you know, like if you've taken your car to get serviced and the oil changed and everything, everything's good. But then there's like a light on the dash that keeps going off. It doesn't actually give you any meaningful information. It's broken, but it's just going off. That's what guilt is. You don't have to set your moral compass according to the guilt. Like you can just sort of let it be in the background. So let me ask you a question about that because this ties to another concept that comes up that you talk about later on under values and it's this idea of the shoulds, right? I should do this, I should do that, right? Which is associated with there's a guilt element of that, right? And there are certainly ways in which we are absorbing the shoulds from the outside world, and they're making us feel guilty. But

I found in my life that guilt is often also the way in which I recognize when I'm not living according to my values. So how do you tell the difference between the guilt that is sort of being put upon you that you just need to sort of ignore, like the broken engine light, like just kind of, okay, yeah, it's there. I'm going to let it be there. The feeling's there. I'm just, but I'm still going to proceed in this direction versus a sign that I'm not living according to what I value. And this is where the should gets really interesting because we've got, you know, it's become a big thing, like don't should on yourself, don't should on yourself. But a lot of times for me, my values end up almost being a should.

Let me say that a different way. It's very difficult for me to tweeze out what is a externally given should that I don't want to live into anymore? And what is an actual internal should that I actually know and believe? And tweezing that apart sometimes feels nearly impossible because we are conditioned at every level all the way through our being. I'm just kind of curious how you think about those different things because to me it's more complex than just saying I'm going to ignore the shoulds and ignore the guilt, because there it's coming from the culture and the expectations of an external environment versus when it's more based on an internal kind of conflict.

And of course, there can be overlap. Right. Right. At times. i think that from what i've seen is that when it's externally based there's more of an urgency like that feeling or like the voice or however your internal dialogue or narrative works like it just it comes really quickly and there's like a panic to it and it usually has sort of like the same quality over a variety of different situations. So whether we're talking about like things in your personal life with your partner, or whether we're talking about something that's going on in your work life with your boss, like there might be a similar tone to the narrative, or there's like just a generally a more urgent sort of feel and a consistent voice whereas the more internally based feedback maybe we could call it i think is is like softer

it doesn't have a as much of like a panicked urgency like it's more like you're reflecting and you're thinking and you're kind of like hmm hmm, oh, okay. Let me, you know, let me go there. Let me let myself sort of like go there and explore that. Whereas the external voice is like, it's not about like go there and explore that. It's like, it's shouting at you. Yeah. That's interesting. And they might be mixed too. Like, right. There can be times where they're mixed and then that's where it's helpful to have a therapist or a coach or, you know, somebody that can be an external, supportive, validating, nonjudgmental person to be able to tease things apart with. I'm Jason Alexander. And I'm Peter Tilden.

And together on the Really Know Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer. Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you and the one bringing back the woolly mammoth.

Plus, does Tom Cruise really do his own stunts? His stuntman reveals the answer. And you never know who's going to drop by. Mr. Bryan Cranston is with us today. How are you, too? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really, No Really, sir.

Bless you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really, no really. Yeah, really. No really.

Go to reallynoreally.com. And register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. It's called Really, No Really, and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts. I'm trying to feel into that experience. I think you're actually right to some degree that the guilt that comes from disappointing someone else

does feel more panicky. Like I've said before on this show, in my life I have noticed like a particular voice that will show up for years. It was, I need a drink, I need a drink. I need a drink. Even after I was sober. And then it transformed from that into what does not sound better, which is, I wish I was dead. I wish I was dead. I wish I was dead. But what I realized when I started to really look at that, I noticed where it most often came up. And it most often came up when I was in a situation where I was

going to have to disappoint someone. Primarily when I was in a situation where there was no way not to disappoint someone. You know, like the decision I'm going to make is either going to make my wife happy and my son unhappy. And that caused in me a sense of despair that isn't the same as when I am feeling internally off track. The phrase, I wish I was dead, right, is so over the top urgent feeling in comparison. And that's where it came up in me. You know, it comes up in those circumstances. And, you know, I love what you said about a mother who can't be in two places at once.

Jenny and I had a similar experience recently. I talked about this at great length on another episode, and I don't know where they come out in relation to each other. But an insight I had, my mom was in Columbus and was having some health challenges. Her mom was in Georgia and was battling dementia. And we went back and forth between the two.

And I realized, you know, I was carrying this weight that like, when I'm in Georgia, my mom's not happy. And when I'm in Ohio, her mom's not happy. And I was carrying that emotional weight until I realized one day, like, oh, wait, it is literally impossible to make them both happy. Like it can't be done. Right. All of a sudden there was a freedom there for me in that. And so I think that was a way of resolving that conundrum. But but I think what you just said that will have both of them feel happy at the same time. And you said that gave you freedom and I think or a sense of freedom. And like one of the ways that I think about that, I think it's a similar thing, is that it's not yours. That it's not your feeling.

The weight of it that you were carrying around was not yours to carry. Yeah. feeling, the weight of it that you were carrying around was not yours to carry. And so maybe that's one of the ways where when I'm talking about like internal versus external, that's a way that it's maybe a little bit of a semantic thing too. But I think, you know, what we're describing here is the whole point of real self-care. And my hope for real self-care is that it invites these deeper conversations in ourselves and with others where we can reflect on how we manage our time, how we think about the expectations that are put on us, and that we have of ourselves. And kind of tease apart all these different threads. Because the answer is, again, they're different for everyone and they're not easy to come to in that you do have to wrestle with it. You do have to kind of work with it. It's not the same as just kind of saying, okay, well, you know, here's the exercise plan. Here's the, you know, here's the 10 step like skincare routine. And I think the other thing about this idea of boundaries is that we get the idea that sort of once we set them or establish them, they're sort of in place, right?

And life is a lot more dynamic than that, right? Like I may set a boundary, which is I'm going to take very good care of my physical health and the way I'm going to do it is X, Y, and Z. And that is my boundary and it's my value. And then there can be a circumstance in which another value of mine, say my dog's well-being, there's a crisis. And that then all of a sudden needs to supplant the boundary that I just set around this thing, right? Like it's not so easy as like you just line your values up one through five and then you just kind of have your marching orders, because life doesn't work that way. Right. You know, life is always throwing different circumstances at us. You know,

there's this idea in in habit creation, you know, we, our cultures become so obsessed with the idea of habits. I mean, I talk a lot about behavior change, and I think they're important. But the key thing in there is that habits only form in a stable context. And most of us don't have stable contexts as our lives. If you're a parent, you do not have a stable context, right? If you have a career on top of it, you probably your career doesn't give you a stable context either, because some weeks you can leave every day at five and other weeks, you know, you've got some big thing and you're like, oh, there's an emergency. I got to be here till nine. Right. You know, and so with the context always shifting, our boundaries also have to be shifting. And that's why I love the idea that you have of the pause. Yes. Yes.

Right. The pause of, okay, given all the circumstances that are at play right now, what's the right wise response for me to allocate my time? Because that's often what we're talking about here, right? We're talking about a time allocation, you know, where I spend my time. Yes. And the flexibility, right? When you kind of think of it as like just a rigid thing, that's actually not helpful. Like we need to be able to cultivate that flexibility. And I think this is probably a nice place to talk about values too, because I think that values, you know, it's the crux of all of this. And the reason that values isn't the first principle is that because you actually do

need to get some understanding of the boundaries and the compassion before you come to values. I think one of the things that I've noticed with my patients is that when i ask them about their values like when i say like well what really matters to you what do you really care about what's most important i get one of two responses either i get like a very stock answer like you know well my kids you know or or my parents which is like that's actually that's not helpful because we all value our children we all value our children. We all value our families, right? And the other piece of that too is a value, it needs to be like an adverb or an adjective. Like it's supposed to be a quality because you can embody the value as you're moving towards the

goal, right? It's not static. Again, pointing to that flexibility. The other interesting response I get is actually anger because people are like, well, I don't have time to think about that. I'm worrying about what's for dinner tonight and who's going to pick up Johnny from soccer practice and who has time, which is true. And it's worthwhile to make time because this is the type of inner work that is an investment. It reaps the rewards. So one of the exercises that I have in Real Self Care for values, and I really love it a lot, and it comes from acceptance and commitment therapies, and it's silly, but it's silly for a reason because I think you do have to sort of like shake things up for people to not be so worried about the shoulds with values.

So imagine you have $200 to throw a dinner party. What is that dinner party going to look like? And you kind of just let your mind go with it. Are we going to be outside in the park? Is my friend who plays in a band going to come play? Is it going to be a potluck and everybody brings their favorite dish from the last state or country that they visited. Or maybe your mind goes through like, you know, sitting down at a table and the color scheme for the placemats. And it's so easy in that little activity or exercise to understand that every single person is going to have a completely different dinner party. There's no best or right dinner party. It really is like it's your preference. It's what you care about. And then from there, then you pull out the adjectives and the adverbs.

And, you know, for one person, it might be like, I want to look around and see everybody in like really deep conversation. And maybe the value is like connection or like intimacy or something like that. But maybe for somebody else, it's like, I want to see everybody dancing and maybe it's like physicality or like embodiment, right? And you play with that because like what you were saying, in different seasons of your life, the values are always changing. You have to be flexible with it. But I share that because I think it's a nice introductory way for folks that are wanting to, you know, take some of this work and try and implement it in their lives right away. You can do that and

then you can play around with it and see like, okay, how do I incorporate that value into my week? How do I take whatever values came out from there and how do I actually put that into my yoga class? Or how do I put it into, I'm training for a marathon. How do I put that into my training? You can take that and put it into, I'm training for a marathon. How do I put that into my training? You can take that and put it anywhere in your life. I love that. I love that exercise. I mean, I've interviewed both Stephen Hayes and Russ Harris and asked them like, what do you think is the best tool for creating values and all that? But I've never heard that one. And I love that idea because it does show how different it is. And, you know, I think values work for me is often overwhelming because,

you know, there's a big list of values and I'm like, well, yeah, I mean, I agree with all those things. Right. And so I think that values work is difficult for people because, you know, you do have to really contemplate fairly deeply and it causes you to recognize that you can't value everything in the same way that contemplating your time, how you spend your time deeply causes you to confront a very similar fact, which is I can't do all the things I want to do. So I have to decide. And, you know, anytime we make a decision about choosing one thing, we're not choosing other things. And that can be deeply uncomfortable. And then the other thing of values I think is so interesting is that sometimes living according to your values is actually a drag. You know, like we talk about it as if, you know, living

according to your values and it's all going to be wonderful. Sometimes that kind of sucks, right? Like, you know, Jenny and I both had a value of taking care of our mother, right? And that caused us to live through a season of life that we did a lot of taking care of our mother, right? And that caused us to live through a season of life that we did a lot of things we didn't particularly want to do if I was just choosing what makes me happy, but were about what we valued, you know? And so, but I'm a huge proponent of values and reflecting more deeply because again, you can't, and I think this is where I think your framework of these four are sort of interdependent or circular, right? Like maybe I start with boundaries to clear out a little bit of space, right?

But after I do my values work, I may come back and change those boundaries because I'm like, oh, wait a second. Now I totally see what I value in a different way than I did before. It often seems like boundaries work is, at least in the beginning, a little messy and then can get refined over time. Yes, yes. And, you know, I was just thinking as you were talking and you're sharing the example of with you and Jenny and your aging parents, like the crux of why you're able to feel the way you do about it now is because you could make meaning of the time and energy that you spent because you named your values and you were very clear and reflecting on that meaning. And I think this is important because I think that many folks are living lives aligned to their values. They just haven't taken the step to name it

and understand the meaning. Yes. It is an extra step. It takes time. But once you do it, it gives you a better understanding of why you're doing what. Yeah, gosh, it really it sucks that I have to drive my kid 30 minutes to soccer practice, you know, every other day. And but then you think like, actually, this soccer team is something that I know he loves and is giving him just such an amazing experience of like middle school or whatever. Right. And then when you name that, it reminds you of the why. Yeah. I could not agree more with what you just said, which is that I do think a lot of people, I don't know if I'll say most people, doesn't even matter,

are living according to their values and they're not connecting the dots. So I use the exact same example you just did, which is, you know, taking my son to soccer practice, right? I would get into this, I have to take him to soccer practice, I have to take him to soccer practice. And then, you know, realize I'm like, no, actually I do not. So why am I doing it? Okay, now I'm connecting to why this thing matters. You know, in my spiritual habits program, I talk about generosity and I'm like, one way to take this lesson is you need to do more. But the other way to take it is you could look at the ways in your life that you actually already are a generous person and connect to those, you know, connect to

the meaning that being a good parent is, right? We just get on autopilot and it just becomes something we keep thinking I have to do, I'm trapped by. But when we reflect on what really matters, we're suddenly like, oh, these things are what really matters. It's just, they're not always as fun as I might like them to be. And, and, but can, you know, making meaning does require that connection that you're, you're talking about. It makes me think of another part in the book that you talk about, and I want to see if I could find it here. You're talking about being too goal-focused and you say, when you're too goal-focused, you spend too much time in the problem-solving part of your brain and you miss out on the good feelings that come when you achieve your goals.

And you said, I think of gratitude not as counting your blessings, but as a form of digestion, right? Talk a little bit about digesting good experiences, because I think it applies to what we're talking about here too, which is digesting the meaning that our lives actually hold. Yes. So this comes from, again, sort of the Buddhist framework of the hungry ghost, those beings inside of us that have those thin necks, but big, big bellies. And so you're just taking in all these experiences, but they're getting stuck. You're not actually digesting the nutrients. So that is one of the ways that I connect to gratitude because I find like the gratitude lists and things like that to be a little bit tyrannical. Like another thing I beat myself up over because I haven't done it right at

the end of the day. So instead thinking of it as looking at what you have and actually being present for it and allowing yourself to fully have it. You know, I was listening to an episode that you did with Greg McCune. I think it was a while ago and he talked about, you know, the way to have more is not to try and get more, but to actually have the things that are already in your life. And I think that's a similar ethos, right? Where you actually engage and are present and enjoy what is already there the reason that i like digestion i guess is because it's calls to mind actually taking in the nutrients and you know it's funny because i think i'm i'm living that right now with you know having my first book out and and all of the things that have come with it that are so great but also like

having to really do some internal work to be present and to allow myself to have it and to give myself that, especially if you're somebody who's admittedly an overachiever and a type A person, it's so easy to just run to the next thing. That's not real self-care, right? You have to stay in what you have. I was also thinking that this is a great segue into power, the last principle. We were talking about meaning and actually naming these connections. And as I was researching for the book and looking at the origins of self-care, one of the things that came out is there's actually two parallel origins. notice there's actually two parallel origins there's people in medical community actually psychiatrists started using self-care as a term to refer to like exercise and diet and and things like picking out your clothes that folks who are in locked psych units could do as like places they

actually had choices while being you know involuntarily committed but then the other side there was audrey lorde and Bell Hooks, the Black queer activists and thinkers who were talking about self-care as self-preservation, especially for marginalized groups. And so with power as the last principle, what I'm trying to do is bring this back to the boundaries, the compassion, the actually aligning and acting according to your values, is that's a way that we take our energy back. That's a way that we actually live some form of resistance against a society that's sort of constantly trying to extract, extract, extract. Anyway, and so I was actually in St. Paul at Macalester University on my book tour,

talking to a group of higher education professionals. And there was a woman there, a professor, she's gay, and she taught queer literature at Macalester. And she said, Pooja, I've read your book, and I really resonate with things you're talking about. But how do I deal with the rage? How do I deal with the fact that there's so much that is unfair and there's so much that's out of my control? And I have students who are gay who come into my office crying and who at times are suicidal. Like, that's the level that I'm dealing with. And I feel like I'm not doing enough. And so we chatted and we talked a little bit more. doing enough. And so we chatted and we talked a little bit more. And she remembered that she writes young adult queer sci-fi novels for fun on the side. She had forgotten about this.

Right? She takes all of her rage and she puts it into these books and she self-publishes them. And, you know, they're on Amazon and that's what she does with the rage she puts it back into the community and create something that is meaningful for young people and just by naming that and making that connection she felt a level of kind of freedom like a little weight was lifted like oh I am doing something that this is my way like maybe I'm not holding a picket sign maybe I'm not running for political office but I'm doing something, that this is my way. Maybe I'm not holding a picket sign. Maybe I'm not running for political office, but I'm doing this. Yeah. Yep. That is a great, great example. And we are at the end of time. We're actually even over the end of time, which is fine because I've loved

this conversation. You and I are going to talk briefly in the post-show conversation. I would love to talk about the real self-care thermometer. How do I know how I'm doing here? And we're going to talk about that in the post-show conversation. Listeners, if you'd like access to the post-show conversation, to ad-free episodes, and the pleasure of supporting a show that really does need your support, you can go to oneufeed.net slash join. Pooja, thank you so much for coming on. This has been a great conversation. I feel like I just sort of abruptly ended it, but I've been trying to find a way to end it for like 20 minutes. And I'm like, I got to hear that. I got

to hear that. So this has been really enjoyable. It's been such a pleasure. Thank you so much for having me, Eric. If what you just heard was helpful to you, please consider making a monthly donation to support the One You Feed podcast. When you join our membership community with this monthly pledge, you get lots of exclusive members-only benefits. It's our way of saying thank you for your support. Now, we are so grateful for the members of our community. We wouldn't be able to do what we do without their support, and we don't take a single dollar for granted. To learn more, make a donation at any level, and become a member of the One You Feed community, go to oneyoufeed.net slash join. The One You Feed podcast would like to sincerely thank our sponsors for supporting the show.

I'm Jason Alexander. And I'm Peter Tilden. And together, our mission on the Really Know Really podcast is to get the true answers to life's baffling questions like. Why the bathroom door doesn't go all the way to the floor. What's in the museum of failure and does your dog truly love you? We have the answer. Go to reallyknowreally.com. And register to win $500, a guest spot on our podcast or a limited edition signed Jason bobblehead.

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