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June 7, 2023
As a physician specializing in women’s mental health, I find this cultural embrace of self-care incomplete at best, and manipulative at worst.
It’s not their fault and it’s not yours. In reality, the game is rigged.
Real self-care, as you’ll see, is not a one-stop shop like a fancy spa retreat or a journaling app; it’s an internal process that involves making difficult decisions that will pay off tenfold in the long run as a life built around the relationships and activities that matter most to you.
As I’ll teach you in this book, real self-care not only impacts us as individuals—it also has a cascade effect in our relationships, communities and workplaces, and society at large. It is what we need not only to buffer ourselves but also to change the systems that are not serving us as women.
me. I started to question what was being taught—I didn’t get much guidance in medical school or residency on what to do when your patient can’t pay for health insurance or when she has lost childcare for the third time in two months and is being fired from her job. Instead, I was taught to prescribe medications or provide psychotherapy for issues that were clearly systemic.
While the practice of orgasmic meditation had helped me personally, I had been seduced by the fantasy that an external solution—this shiny wellness practice—could fix all of the problems in my life. Instead, I learned the hard way that self-care is an inside job.
In the decade since then, I’ve come to understand that real self-care is not only a more authentic and sustainable solution—it’s also self-determined. It involves the internal process of setting boundaries, learning to treat yourself with compassion, making choices that bring you closer to yourself, and living a life aligned with your values.
self-care industrial complex.
If it’s someone else’s answer, it can never be your solution.
This work isn’t about fixing yourself—in fact, it’s high time we stop telling women they need to be fixed. Instead, I will teach you how to care for yourself from the inside and, in turn, create a cascade effect that influences your family, your relationships, and even your workplace.
Instead, I will invite you to take a close look at how you spend your time and how you talk to yourself, so you can make clear decisions about aligning your behaviors with what matters most to you.
We’ll also dive into the three main ways women are understandably seduced into faux self-care as a coping mechanism: escape, achievement, and optimization.
eudaimonic well-being and why real self-care is grounded in this psychological concept.
the Four Principles of Real Self-Care: 1. Set boundaries with others. 2. Change how you talk to yourself. 3. Bring in what matters most to you. 4. This is power—use it for good.
In a country without mandatory paid family leave and with astronomical childcare costs, parenthood can be an existential tipping point for women. But it is important to note that it’s not just mothers who suffer from this overburdening—it’s anyone who has been conditioned to put the needs and preferences of others ahead of themselves.
This is precisely why we must shift away from a commodified version of wellness, which continues to uphold and perpetuate inequitable systems of power.
Her focus on productivity was theoretically in service of finding time to do self-care, yet Hina could never quite pour the time she gained back into herself.
A common refrain I hear in my practice is “I’m burned out, I just can’t do it anymore, and I feel like it’s my fault because I should be taking care of myself.”
Our culture has taken wellness and foisted it on the individual—where it can be bought, measured, and held up as personal success—instead of investing in making our social systems healthy.
When I couldn’t keep up with the rigid yoga schedule I had outlined, I quickly chalked myself up as a failure.
Faux self-care is faux because when used alone, without the critical internal work we will discuss in this book, it does nothing to change our larger systems.
It turns out that self-care has two major lines of origin: health care and social justice.
Audre Lorde defined self-care as a powerful act to reclaim space within a society that demanded minorities and oppressed groups stay small or invisible. As she wrote in her 1988 book, A Burst of Light, “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Self-care was no longer relegated to the realm of health, nor was it about standing up against oppressive systems. Instead, it morphed into a release valve, designed to bring you a momentary sense that things are all right.
(Interestingly, Google searches for self-care peaked in November 2016, following election night in the United States.)
It’s in this context, where actual treatment for mental health conditions is inaccessible for the vast majority of folks, that our culture serves us faux self-care as a quick fix and as a poor substitute for professional help.
“A method may be useful once, to solve one specific type of problem. Principles, however, can be applied broadly and repeatedly.”
As we move through the book, you will understand how your own methods of real self-care will differ based on your particular situation. But the principles are remarkably consistent. If you start implementing these principles in your life (and you don’t even need to do it perfectly—you just need to start), then you’ll find that your unique methods for real self-care become clear to you.
Requires learning to cope with feelings of guilt as part of the process Comes with a short-term emotional cost, in order to reap longer-term emotional gains
What I meant when I said “I don’t have time” is that every minute that passes I’m disappointing someone . . . KATE BAER
Over a lunch of quinoa and butternut squash, they told me that Esalen was their vacation. I noticed myself feeling personally offended and morally outraged—this wasn’t a vacation! I was here to do serious work!
I’ll lead you through the three most common reasons why we turn to faux self-care: Escape Achievement Optimization
she not only felt pampered—she felt deeply cared for, albeit by strangers. This was a welcome change for Monique, who in her real life did not allow herself to be cared for by others and instead relished the role of caregiver. Who doesn’t love feeling pampered and catered to? But it never translated into real change:
Using self-care to escape our regular lives—while temporarily enjoyable—seldom results in lasting change. That’s because our true selves are located in our daily choices, and when you use faux self-care as a coping method to escape, you don’t have to make any real-world decisions at all.
these temporary escapes allow us to (for a moment, at least) get rid of the tough decisions that need to be made in daily life. And who among us doesn’t feel a sense of lightness, even euphoria, when we think about escaping from the daily grind?
But the truth is, the trappings of our daily lives, the interpersonal struggles, dealing with the internal conflicts—all of this makes us who we are. It’s in the decisions we make in the real world that we mold ourselves and discover what truly matters. I understand that sometimes this just feels way too hard:
As I’ll get much more into in the next chapter, women in particular live in a world where we are not given the privilege of time or space for reflection.
Through our work together, we came to understand that the “self-care” Sharon had been engaged in during her time at her job, and even after the layoff, had been a means to an end: Her goal was to win, and to make sure the people in her life knew she was a winner.
That’s because Sharon, at her core, had a deep-seated feeling of worthlessness. From a young age she had developed a shield of perfectionism.
That was because her self-care was not grounded in caring or compassion for herself.
Many of us grow up with a feeling that we are not good enough just the way we are.
The drive to succeed, often unconsciously motivated by shame, commonly manifests in a relentless pursuit of faux self-care achievements, none of which actually nourish our true selves.
Unlike women who use faux self-care as an escape, which at least feels like a relief even if it doesn’t provide lasting benefits, women who engage in achievement-oriented, performative self-care often buckle under its weight.
Unfortunately, it’s impossible for these external activities to sustainably produce the feelings we are looking for them to deliver—worthiness, acceptance, relief. For
Anita therefore approached organizing her household the same way she approached running her small business: with hypercompetence and an emphasis on productivity and control.
Anita could not turn her brain off and stop herself from thinking about what she could be doing better. When there were items on her list that she didn’t get to, she felt uncomfortable and anxious.
Was she really being the “best” version of herself? Here, we realized, “best” was synonymous with most efficient, productive, and controlled—not with fulfilled or content.
It promises us that someday we can reach a pinnacle of productivity and efficiency such that our life will finally feel like it’s fully under our control. But the problem is that we never actually arrive, because we haven’t been taught the critical step of identifying the principles.
The areas of the brain that you use when you’re working on your to-do list are located in the prefrontal cortex. The prefrontal cortex, or the thinking brain, very much wants to make sense of the world—it wants order and control. But the other, more primitive parts of the brain, which include areas like the limbic system, are where we experience connection, empathy, and other important emotions.
I realized that I felt more comfortable with productivity because it provided the illusion of control.
