"The system is rigged and the game is fucked"
Talking about wellness culture, burnout, performativity, and agency with Dr. Pooja Lakshmin, author of Real Self-Care
A few times in my life, I’ve picked up self-help books and become a temporary evangelist of the program they outline. Usually this happens in times when—I’m not happy. I need some new worldview, some new narrative pattern, on which I can hang my life. In my first memoir, I wrote briefly about a book I picked up in college, which taught me to monitor and manage my emotions, tracking whether I was above or below the line. This proved tough because, basically, I was super high all the time and riddled with anxiety. I tried to find the name of that book for this introduction, but it’s lost to me now, though many self-help books, I think, use similar language.
When I got sober, it was in part because I read
’s Quit Like a Woman. Growing up in a household where alcoholism hurt me deeply, and then, later, was treated as this ominous, aberrant disease from which my by-then-sober mother had escaped, I had no narrative that allowed me to see the damage alcohol did to my life, and the lives of those in my family, as anything other than an individual problem. I needed Whitaker’s narrative, her clear articulation of what I felt but couldn’t name. I ate it up, huffed the pages, could have eaten them. Finally I could see my sobriety, my recovery, as something radical, rather than disempowering.The thing about life is, no one story can last. Existential and material and emotional and political and personal crises evolve. So do we. We are always rewriting. My recovery story changed over time, became more complex, as I noticed my new sobriety was entangled with consumerism. But I had to cling to that new story I found in a book for a time to get anywhere new— to begin to play, as author of the new book Real Self-Care
puts it, an entirely new game.This conversation was supposed to arrive in your inbox a few weeks ago, but Pooja asked for an extension because she’s been busy launching her book. We considered publishing our email exchange to show how Pooja is putting into practice her own methods. There was a lot of honesty and frankness in our exchange. I get it. She gets it. But creating space and flexibility in work lives isn’t always so easy. Some people don’t get it.
Rather than offer in her book some universal program, however, Pooja invites readers to do more complex work— the kind money cannot buy, and the kind that changes over time. In addition to writing and publishing, Pooja also runs the women’s mental health platform Gemma, and their newsletter
. In our conversation below, we dig into what she calls the “tyranny of self-care,” labor extraction, the genre of self-help, “the paradox of choice,” and the parallels between motherhood and authorship. I hope it’s a story you can hang on to for awhile, but also one that invites you keep writing.
You open the book discussing how “self care” and wellness tend to produce guilt and self-blame, rather than comfort and solace. This “tyranny of self-care,” you write, is rooted in our individualistic culture and in consumerism, but also a cultural emphasis on efficiency and self-optimization. How do capitalism, racism, colonialism, and other systems of power factor in here?
My thought process around this came originally from the plight of healthcare workers, who experience moral injury in the context of a toxic and exploitative corporate medicine model that devalues the humanity of healthcare workers and patients alike, and exalts productivity and the dollar as the end-all be-all. I learned all of this in the mid-2010’s as a burnt out resident physician who was trying to understand how to keep being a doctor, but not lose my own mental health.
Then, I became a perinatal psychiatrist (I specialize in working with women who are dealing with PMADS), and saw the same pyramid scheme happening in my motherhood. Take for example this seemingly simple medical data: when a new mom can get 4 consecutive hours of sleep during a 24 hour period, she is less likely to develop postpartum depression. Sounds simple, right? Yet, if you have had a baby or are a partner or a friend of someone who has had a baby, you know that the ability to get 4 hours of sleep in a row for a new birthing person is entirely dependent on a huge number of social and economic constraints.
When a new mom can get 4 consecutive hours of sleep during a 24 hour period, she is less likely to develop postpartum depression. Sounds simple, right?
To name a few: Do you have paid parental leave? Do you have a partner? Do you have a partner with access to paid leave? How are you feeding your baby? Do you feel like you have agency in those choices? The list goes on and on. I realized the same exact thing can be said about “self-care.” I don’t have a patient in my practice who has the luxury of being able to spend 2 hours getting a massage, let alone spending 15 minutes meditating. Self-care as it’s sold to us becomes another thing on the to-do list to feel bad about.
Why is this? Well, it comes back to time, which you wrote about so beautifully in a recent Mad Mom’s piece.
The way I think about this is very much built on the seminal work of Isabel Wilkerson’s masterpiece Caste, which, as a 1.5 generation South Asian American, spoke to me so deeply. The entire premise of capitalism is based on exploiting the labor of people who have darker skin. (Wilkerson’s Caste is a must read for folks who maybe don’t see this yet.) The interconnection between capitalism and white supremacy lives in the fact that both were built together in service of extracting productivity (eg. Value) from someone that society has arbitrarily deemed as “less than.”
We see that dynamic play out everywhere. The line from there to the wellness industry telling women that the answer to their “burnout” is a tincture or an essential oil—as opposed to say, federal paid parental leave or affordable health insurance, which covers mental health care services—is not surprising. Because when the problem is inside of you, and the solution is something to be bought, then nobody asks deeper questions, the system keeps running as is, and the same people who have always been in power stay in power.
So, in Real Self-Care, my critique is structural, and my “solution” is personal, not commercial. Because only when the solution is personal (meaning, that it lives inside you, and is in your choices and behavior), do we have a chance of getting to collective action. A bubble bath could never do that.
I am not a big self-help book reader because of the some of the issues you mention related to consumerist wellness, and I’ve been openly critical of parenting advice, which has its own tyrannical tendencies. But I really enjoyed this book, not only because I am a fan of your work, but because you strike a delicate balance between diagnosing a problem and offering solutions AND allowing readers to locate their own solutions. The book feels more like a conversation with an expert (who is also wary of expert advice!) than a prescription. Did you think about striking this balance while writing the book?
This is probably the thing that I thought (and, ruminated!) about THE MOST in writing Real Self-Care. I spent countless hours with my own psychoanalyst talking about it, in terms of my own psyche, ego, and trauma, but also in the sense of does the world need another self-help book and/or am I adding to the problem by writing a self-help book? As I’ve been doing press for the book I’ve been saying that this is a self-help book for people that roll their eyes at self-help.
It’s a great question because I did not set out to write a self-help book. My proposal for Real Self-Care was very big think and problem focused. It came out of some of my previous writing on the topic. When I got the first chunk of my book advance, I hired the amazing editor Jenna Land Free (who is now a literary agent!), and she set out a schedule for me, which I promptly fell off because I was also going through IVF. Jenna basically was my frontal cortex in the writing because I would just write what I wanted to say, and then she would read my word vomit and ask me questions about what I was trying to convey.
As it all came together, I realized that the only way for this book to actually be useful was for it to be prescriptive. We all know the system is rigged and the game is fucked. What we really need is someone who has been in the shit too, and is trying to make sense of it, and who has the clinical expertise and credentials to shine a flashlight on what matters.
Because of my history in the cult, it was very important to me to not convey any of this as “The Answer.” So, I appreciate you pulling out this thread—because yes, I did try really hard to keep coming back to the fact that the answer is in The Questions. Asking yourself new and different questions and then sitting with the uncertainty and scariness of your own answers.
We all know the system is rigged and the game is fucked.
As I’ve been doing press for the book, I keep saying that nothing I say in the book is revolutionary or groundbreaking. Sometimes friends push back on that and tell me that I’m talking myself down. There might be some truth there, but I think it’s more nuanced. I do think it’s important to acknowledge that so much of self-help is saying the same stuff. There are lots of folks in this space that I respect and many of us say similar things. That said, if you are someone who is a thinker or a reader or a listener, I think the most important thing is finding the voices you respect who align with your worldview and then holding what they say lightly. None of this can be passive—it all must be a conversation.
My hope is that part of my contribution to the “field” of self-help as a psychiatrist and physician is to bring a critical systems analysis— to point the conversation in the direction of social determinants of health—and then to acknowledge time and time again that there is no easy or simple path. The hard work always must be done by the individual because it’s your life. No quote card on Instagram is going to do that for you, and even a self-help book won’t do it for you.
This seems related to what you call “the paradox of choice.” I’ve been thinking a lot lately about how choice has become increasingly weaponized against women. It’s part of the most recent backlash against feminism, but also rooted in an unfinished conversation about choice— i.e. who gets to have choices in what context, who doesn’t, and how is free will distributed unevenly in America? As you write, even when women do hard internal work, they are still playing a game they cannot win— and some women more than others. Can you sum up the approaches you propose women must embrace for, as you say, “true change to happen”?
It feels like a Catch-22, right? If we get stuck in a feeling of powerlessness about how the system is stacked against us, change does not occur. If we throw ourselves into faux self-care and align ourselves with the capitalistic and patriarchal structures that be, we internalize the sickness and exonerate the system.
We can't do either of these things.
Instead, for true change to happen—for real self-care to lead all of us to a more equitable and equal social structure—we as women must do two things: embrace internal change, and cultivate what's called “dialectical thinking.”
On the first, I quote Audre Lorde, who said: “For the master's tools will never dismantle the master’s house. They may allow us to temporarily beat him at his own game, but they will never enable us to bring about genuine change.”
So, we must aim for something completely different—a solution that challenges everything we have come to know. Real self-care is an internal solution. This means that there will be times when it seems and feels like you are “losing” but in fact you are playing a different game altogether. One in which your feelings—your personhood and humanity—are invaluable. Only you can shift the game to that new orientation.
Dialectical thinking means that you can hold in your mind the idea that two opposites can be true simultaneously. There is a specific type of therapy, called DBT, that teaches this skill. The founder of DBT, Marsha Linehan, refers to it as an integration of opposites.
In Real Self-Care I share the example of a patient, Mikaleh, who was facing a dialectic in her life as the caregiver for her sick father: she loved him dearly and realized that she alone could not care for him. Both of those statements were true and neither discounted the other (even though she had grown up with a narrative that told her one proved and performed their love for others by showing up selflessly). Reconciling the dialectic here meant that Mikaleh had to recognize that she could live her life with both truths occupying space in her mind. When she made this internal shift, then she was able to make decisions from a place of agency instead of fear or shame.
…there will be times when it seems and feels like you are “losing” but in fact you are playing a different game altogether.
I love that you give readers permission to be “good enough,” a concept that comes from DW Winnicott’s theory of the “good enough” mother. One thing I appreciate about Winnicott’s theory is that it underlines how a mother’s expression of her own complex emotions teaches children to handle a range of feelings. But we live in a time when the “good enough” mother has been replaced by a glut of expert advice. What, in your mind, are some of the primary challenges mothers and parents and people face in trying to feel like they really are good enough?
I’d love to answer this question with some new thoughts that have been coming up for me as I’m inside the Real Self-Care book launch and book tour, especially since I know you will be inside this slice of life, again, very soon!
This is my first book and what I’ve come to understand is that this beast is similar to many of the others we write and talk about collectively—motherhood, womaning— because so much of it is caretaking work. Launching a book requires a huge amount of creative energy and the emotional labor is unseen and devalued. Book launches tend to have a parallel performance to that of motherhood, especially on social media—to have the events, to show up polished, to have the perfect anecdotes and talking points. In most cases, the cognitive and emotional labor all falls on the author (like it all falls on the mother) to orchestrate and to perform.
[AM note:
also wrote beautifully about this parallel recently here]It’s been hard for me to keep up with the performance and even some of the orchestration. I’ve canceled podcasts at the last minute because I just could not get out of bed. I’ve made awkward IG posts. I am a month late here, in this conversation with you! I usually show up to stuff in a messy bun and a headband. And of course my workload right now is terrible—the book, keeping up with my patients in my clinical practice and Gemma, it’s for sure impacted my mothering. My son is 10 months old and probably because I did not have the energy for BLW, he now refuses to feed himself while at home (he feeds himself at day care though! sigh).
I bring this back to the systems again—publishing is a field that is deeply impacted by economic constraints. Identity and privilege play a role. The whole concept of birthing a book into the world is primarily interpersonal—who you talk to about the thing, what those conversations feel like, how you post about it on social and who engages with you—and these interpersonal parts come with big feelings. The performance of it does not acknowledge any of that.
I hope I am not coming off as angry or ungrateful. This is what a very successful book launch looks like. You can come out of a very successful book launch and be hobbled by the end of it. Truthfully, that’s where I am a bit. I wrote about it in Therapy Takeaway, the Substack I co-write with my colleagues at Gemma. I’m being transparent here because I do think it’s important for folks to know that even when things seem glitzy on Instagram, the reality of it is usually not glamorous.
So to finally answer your question—comparison is what gets us. You have to understand that nobody is living the life that is their Instagram page, even the most successful beautiful people. Needing to spend the evenings zoning out to bad TV, while your friend has the energy to go to yoga, doesn’t make you a bad woman or a bad mom (and canceling podcast interviews doesn’t make you a bad author!). This is absolutely something I still struggle with and have to work on in my own therapy too.
Coming back to what we talked about earlier, if in your game the person that wins is the one “who can do it all, and make it look pretty and easy” and you are failing at that game, then maybe you need a different game? I think that is the game we see played out for motherhood on social media, but it’s also the game we see being played out for authors too (many of whom are mothers!). Let’s play a different game—one in which we are transparent about our struggles, our failings, the places it’s messy and hard. Not in a performative way, I hope, but in a way that brings us closer together as opposed to making us more defensive or judgmental.
…if in your game the person that wins is the one “who can do it all, and make it look pretty and easy” and you are failing at that game, then maybe you need a different game?
YES. So, I wonder how sexuality might fit in here, since a lot of what you’re talking about is related to undoing gendered cultural expectations and finding what you call in the book an inner “compass.” I am curious—especially given what you share openly in the book about being involved in a women’s empowerment group that focused on female orgasm!—is there some link between finding that internal guide, as well as that new game, and awakening our own relationship to pleasure and desire?
Is it okay for me to give you the transparent and not fully processed answer here?
Of course!
I think it absolutely fits, is central, and I’m not sure yet how to write or talk about it. There is so much great work on embodiment. One of my current favorites is Kaitlin Curtice’s Living Resistance. Kaitlin writes about embodiment as resistance, and I think that is spot on. I think because of where I’ve been with the pursuit of embodiment, in the form of female orgasm and meditation, I am still trying to figure out my answers here.
I can say that a couple weeks ago I had a great conversation with Dr. Lucy Hutner MD, a good friend and a founding psychiatrist at Gemma, our women’s mental health platform, where we were talking a little bit about this. I was sharing with Lucy my feelings about “coming out” with my history in that women’s group, and how it’s been heavy and hard for me at times during the book launch. She said something about how the fact that I went to such an extreme length—immersing myself so deeply in something so physical—tells us something about just how disembodied modern medicine is, and how hurt I was.
Pooja and I will be picking up this last question, and likely many others, in an exchange we have planned later this year— details to come. For now, feel free to comment below with questions and topics you’d like us to explore further in our future conversations together.
(Comments are now only available to paid subscribers— Substack’s new Notes feature, which is so far otherwise fun, has caused some unsubscribed trolls to leak in here, and I’d like to keep them out of our discussions.)
In the meantime, I have a few classes coming up that I’m really excited about:
Writing the Home with Minna Dubin, author of Mom Rage, online via Zoom, one day only, a generative and community-building session on writing the bodies and feelings that circulate in domestic spaces, Sunday, May 7 9:30am-11:30am PST
Discovering Your Memoir’s Form at Writing Workshops, starts this Monday, April 17th, online, go at your own pace, get feedback from others and figure out the structure of your in-progress book, no Zooms
Writing Against Patriarchal Power at Hugo House, starts next Friday April 20, weekly Zooms to discuss craft and generate new writing, no outside “homework”
