The Ezra Klein Show: A Skeptical Look at ‘Self-Care’

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From New York Times Opinion, this is the Ezra Klein Show.

Hey, it is Ezra. I am on book leave this week, but we have the great Tressie

McMillan Cottom sitting in the chair. She is a Times Opinion columnist. She is the author of

Lower Ed, the troubling rise of for-profit colleges in the new economy and the National

Book Award nominee, Thicke. She has been a guest on the show before, a host on the show before

her episodes, no matter where she is sitting and which chair are always some of my favorite.

So I'm excited to hear what she does this week and I hope you enjoy it too.

And before we begin, one more thing today. So I am doing the annual Jefferson Memorial Lecture

for UC Berkeley, which I'm excited about as a kid who grew up in California,

idolizing and then getting repeatedly rejected by UC Berkeley when I applied there.

And it's going to be the first time I try to work through the ideas of the book in public,

with an audience, in conversation, with someone else who knows what they're talking about on

these issues, Amy Lerman in this case. And if you'd like to join and hear what I've been thinking

about, you can. Tickets are available at calperformance.org. We'll put the link to the

event page in show notes. And again, that is October 5th at UC Berkeley.

Today's multi-billion-dollar self-care industry has some surprising overlap with the radical

feminist idea that care could counter the ills of capitalism's self-interest.

It is now pretty hard to disentangle the radical roots of self-care from the consumer's way we

tend to go about it. The idea of taking care of yourself is not merely virtuous. It's become

a cultural expectation. The catch-22 of self-care becoming big business is that taking time to

refuel, recharge, and reconnect as self-care asks of us ends up feeling like just another

productivity chore, the kind that led us to burn out in the first place.

Puja Lakshmin is a psychiatrist and the author of real self-care. She argues that self-care

isn't about lighting a candle or making more time for yoga. It is instead about internal work,

which she outlines as four practices. Setting boundaries, practicing self-compassion,

aligning your values, and exercising power. Lakshmin argues that when you practice this real

self-care, you not only take care of yourself, but you can plant the seeds for change in your

community. I invited Lakshmin onto the show to discuss why the easy one-size-fits-all self-care

culture is both alluring and misguided, why setting boundaries is difficult, but absolutely

critical to self-care, and what tools might help us to take better care of ourselves and the

communities that we are a part of. As always, the show's email is EzraKlineShow at nytimes.com.

Welcome to the show, Puja Lakshmin. How are you today?

I'm doing so well. I'm so excited to be here, trustee.

So I wanted us to have this conversation in part because, I don't know, I've got a little beef

with self-care. Okay, so if I were to walk into your office and you started saying self-care to me,

I would go, I'm throwing up my hands at you just so you know. What might you say to someone like me?

Well, first I will say, you and all my patients, right?

Okay. All right, so it's not just me.

It's not just you. I think that everybody either rolls their eyes to the word self-care is, you

know, just kind of like, there's this visceral sort of like, you know, with my patients, it's like,

how? With what time? Like, you're asking me to do more? There's this like, almost like a rage that

can come up? Yeah, it's sometimes orders on rage about what gets wrapped up in the self-care movement

and what's organized under the banner of self-care. I don't like the cult of personality,

of self-care-ness. I think the sort of gupification of self-care and wellness as a personality-driven,

influencer-driven cultural phenomenon really distracts us from the fact that there is a lot of real,

urgent, structural, pain experience that intersects with a lot of inequality,

a lot of unequal experience of the world, that I just don't think self-care is designed to do

anything about and worse than being just neutral. If it was just neutral, like you said, I'd just

roll my eyes. I don't think it's neutral though. I think it's worse than neutral in some cases.

I think it actually can make it worse. It can make that inequality worse by saying,

if these things don't work for you, it is your fault. So when I look at this sort of like,

deification of a wellness influencer who, let me be honest with you, very often wealthy, white,

genetically gifted in a million ways, but the people who around me who I think really need to

be cared for are not those things, I get a little ragey. Yeah. Well, I would say that

the rage is productive because it's true. And maybe taking a step back, one, I wish that I had a better

word besides self-care. And as I was writing the book, I thought of all these technical words like

eudaimonia, psychological flexibility, and everyone's like, that's not a book title.

And I did think that we needed a treatment of actually reclaiming self-care, like having

something that was going to appeal to the folks who go to gloop and maybe are coming to understand

that it's not working and also appeal to folks who are coming to this from the social justice side

and the side of understanding that we don't live in Americanocracy, in America,

you know, white supremacy, and what I've been learning to call it greedy capitalism

makes us all feel like we should be able to wellness our way into feeling better,

but what we actually need is things like paid parental leave, affordable, equitable health

insurance, etc. So how do you find a way to bring all those people into a framework that

is accessible? And so I stuck with self-care, even though that the word or the term in itself

can turn people off or on. So what I decided to do is kind of put it into two buckets,

faux self-care versus real self-care. And when I describe the faux self-care, I'm saying that that

is what we're kind of rolling our eyes at. That is the essential oils, that's the

turmeric lattes, the bullet journals, the whatever, like you can insert.

Oh, the bullet journals. I've bullet journaled so many times. Okay. Yeah, the bullet journals.

Yes. So it's something you get from the outside. It's something that you buy. It's something that

you do. Usually your hopes are really high. And I think actually the bullet journals are interesting

because it's a specific, very smart person that isn't going to fall for the essential oils,

but you are going to believe that if you get that right bullet journal system,

that your whole world will no longer feel like chaos and that you will be in control.

You are calling out my stationery addiction with a precision that I find disturbing. But yes, okay.

But right, like the productivity panacea is, I think, the erudite version of wellness.

And I call all of that faux because it comes outside of you and it maintains the status quo

in your relationships and in our broader social structures. If it's okay, I want to share a little

bit about kind of like how I came to this framework myself. Please do. So I'm a perinatal psychiatrist.

I specialize in women's mental health. And when I started practicing graduated residency in about

2016, now I only take care of women. But at that time, I was mostly taking care of women,

most of whom were pregnant, postpartum. And one of the evidence-based ways to reduce the risk of

postpartum depression is to get four to six consecutive hours of anchor sleep in the postpartum

period. And we were taught to just like say that, you know, like, okay, get four to six hours of

sleep postpartum. And if anybody who's listening has either taken care of an infant or baby or had

one themselves, you know, like, how am I supposed to do that? Like, yeah, people would love that.

Like no one is fighting that. Nobody is fighting that. The ability to sleep postpartum is hugely

impacted by social determinants of health. It's hugely impacted by, are you a partnered person

or are you a single person taking care of this baby? Do you have grandparents who live close by?

Do you have the money to have a doula or a night nurse? On top of that, do you have the

education to understand your feeding decisions? So that was kind of the beginning of me becoming

a little bit radicalized about social determinants of health, which still in psychiatry, you know,

it's getting better, but that's still a sore spot, you could say, especially given psychiatry's

history. And then the pandemic happened. And collectively, I think, a wealthier and more

white swath of the population came to understand things like the importance of child care and

why we needed to have things like paid leave. And that's when I started to see some of this

wellness speak happening. And I, it was just a little bit before the pandemic that I wrote a piece

focused on women in medicine called, we don't need self care, we need boundaries.

And it was really kind of getting at this, like, when we're blaming the individual for something

like burnout, we're actually exonerating the broken social structures. And so I guess what I'm

trying to do with real self care is thread that needle of like, where does individual

action fit into collective action? And my take as a psychiatrist is that

the two are intimately connected. And I know we can talk more about that. But I think that's a

crucial thread of this whole new framework for thinking about self care.

So let's talk about your piece for the New York Times Primal Scream series in 2021,

which you explored the untenable burdens that the pandemic had put on working mothers in particular,

where for the first time, many Americans were living as some Americans had been living

regularly, dealing with the burden of child care when you couldn't outsource some of that

domestic labor, for example, or trying to deal with outsourcing what you had been able to rely

on transportation, right, public transportation to manage or had been relying on your school system

to manage for you. And disproportionately, that labor, the responsibility for managing it fell

on women on mothers. And in your essay, you talked about the difference between burnout

and betrayal. What is the difference, the distinction you're making there?

So burnout, of course, there's a clinical triad to burnout, emotional exhaustion,

depersonalization, which basically means that you feel sort of outside of yourself.

And then a decreased sense of meaning with what's happening in your life. I sum it up as

the patient who comes in and has everything that they supposedly want in their life,

but then they look around and kind of have this feeling of like, well, is this all there is?

Like everything sort of feels empty, even though there's so much. Collectively, we've decided to

call that burnout. But that's a very individualistic way of thinking about a condition that actually

comes from our social systems and the collective decisions that policymakers, lawmakers,

governments, corporations have decided to make, which you know much more about than I do. But

as I was preparing for this interview, I was just quickly glancing at the HHS website.

And it says on the HHS website, burnout is a condition that is a result of workplace conditions.

So why do we call it burnout? It's coming because of the environment.

And I think the other thing here is just the importance of the words that we use.

There is a researcher, Caitlin Collins, who writes about gender equity in

parental leave policies. And she has a book out where she interviews mothers in the United States,

Italy, Sweden, and she talks about how where they have a robust social safety net,

mothers talk about their right for parental leave. Whereas in the U.S., when someone gets maybe just

like four weeks of leave from their employer, it's a benefit. But the difference in that, right,

who is responsible for taking care of that caregiver? In the U.S., it's always up to us.

And then even when everything falls apart, it's our fault.

And so when you talk about betrayal, how can self-care respond to that kind of betrayal? Can it?

So my thesis is that instead of thinking of self-care as taking 15 minutes out of your day

to meditate or go for a walk, that we need to be thinking about self-care as something that is

threaded through every single decision you make in your life. The small decisions

and the big decisions. So it's not a task to check off of your list. It's actually

something to embody. There's different levels of this, for sure, especially if you're somebody who

is in a particularly demanding season of your life, let's say, parenting or taking care of

elderly, aging parents, any type of caregiving situation, you might be feeling like you're

drowning. So then you need just a life raft, right? And there's a version of real self-care

that is that life raft. I call that sort of like 101. And then maybe the 400 level of real

self-care is like looking at these harder big life decisions like, what is my career going to be?

Do I want to have a partner? Do I want to be a mother or not or parent or not?

How do I want to live? Where do I want to live? And when you deconstruct these choices,

the framework that I'm suggesting is that there's these four pillars we can talk about,

boundaries, compassion, values, power. When you deconstruct that and you decide to make choices

in your life based on your own values, not society's values, not culture's values,

that that's actually deeply subversive. And this, of course, builds on the work of Audrey

Lord, Bell Hooks, black queer thinkers. That's not an accident at all, that those were the folks

who put this work into our cultural conversation. And I think that especially for

women of color, for marginalized groups, for black women, anybody who is

because of their identities on the outside, self-care, this version of self-care can feel

actually even, I almost want to use the word violent because it's self-preservation,

like Audrey Lord said, and there is a survival aspect to it.

The one last thing I want to say, just as we're sort of diving into this,

is that I think of like the faux self-care stuff, if it's the yoga class or the meditation or

the sound bath or whatever, like those are all tools, right? And sometimes the tools are helpful,

sometimes they turn competitive, sometimes it's more of just an escape. The thing with the tool

is that you can use it for a time-limited period for a very specific end, but real self-care is

a principle. It's something that can stay with you over the course of time through different seasons

in your life. And so that's why with the boundaries, the compassion, the values, and the power,

it's sort of about changing your thinking as to how you make decisions in your life,

and then seeing how that impacts other people as well.

All right. So I have made a lot of those sort of like big decisions in my life here lately.

I have tweaked my professional life in some big and medium-sized ways

to align with my values and all of those things.

I sold my house and bought a new one to live in a way that felt more authentic. I did all

those big things. And can I be honest with you? Please. It sucked. I mean, the big decisions,

you know, hard, like in the immediate, I can't say that I think it felt particularly

enjoyable. I have to keep revisiting my notebook to remind myself, why did I do these things?

When I'm in the middle of the moving, in the middle of the reallocating my life,

you know, moving all your stuff around, I have to find a new grocery store, I have to change

all the things. Like I just keep going, why did I do this? Whereas on the other hand,

let me tell you what happens to me. I was standing in the William Sonoma a few weeks ago.

And, you know, William Sonoma has everything organized in those little bins and the little

vignettes, you know, how they style the things. And I'm standing in front of one and listen,

I don't even like candles. I'm not one of those people. I don't like the strong, aggressive

sense. I'm not a big candle person. And then yet there I was in front of one of those styled,

organized little vignettes that featured some candles. And you know what I did, you know what

happened? You know, I'm the proud new owner of two William Sonoma orange essence, something or

the other candles. I don't even like candles. So, but in the moment, that felt known and easy.

And so I understand why this faux self-care as ineffective as it is, it's a $10 billion

industry by some accounts. And I can totally imagine, by the way, that we underestimate that.

I imagine we're not counting some things that should be included. But by some estimations,

a $10 billion industry, whereas I get the other stuff, ultimately, more important to my quality

of life, my well-being in the short term, doesn't feel as good. What do we say about the effectiveness

and the feelings of these things when you put the faux self-care up against the real self-care?

How do we manage the emotions of those two? One has got us by the emotions. The other,

I won't lie to you right now. I'm not feeling happy honky-dory about my

aligning with my principles right now. I'm not feeling overjoyed.

Do you want my Dr. Lakshman response or do you want my Pooja response or do you want both?

I would like both.

Okay. Let me start with Dr. Lakshman. Everything that you're describing sounds

completely reasonable and normal because you're in the hard part of the transition.

Okay. Like you're in the work. You're still in that space where you made those big decisions

and it takes time to reorganize, figure out where your grocery store is, unpack all the boxes,

figure out what all the things are, find your new favorite barista at the coffee

shop that you go to, make those communal relationships too, and figure out who is

Tressie in this new place. Just based on what I've read of your work, I understand you to be

somebody who cares a lot about her environment and where you live. What your space is like,

your physical space. So you're in that phase right now where you're having to curate that

and it's a different physical space. Your nervous system, your brain, your body is doing a lot of

what I call back of house work, unconscious work of learning this new house,

learning the new rooms, learning your neighborhood, and that's not available to you. That's just

running in the background. So that's my take. It's not that you made the wrong choices. It's

that you're in the space of like, you made the right choices, but now there's still work to do

to like reap the reward of said choices. So doing the right thing doesn't always feel

good immediately. Correct. And that's an important point because the whole concept of

real self-care is based on this term eudaimonic well-being as opposed to hedonic well-being.

So hedonic well-being is the like giant 600 calorie Starbucks milkshake that they're calling

a coffee, right? That's pleasure, right? It's a sugar rush or it's the absence of suffering.

Whereas eudaimonic well-being is a life that is built on meaning and purpose. And when you

understand that your activities and your relationships and how you spend your time and energy

is aligned with what is most important to you, i.e. your values. And the important piece there is

that, you know, if you look up values in the dictionary, one of the definitions is that it's

a preference of what you decide to be most important in your life. It's a preference.

Everybody's values are different. And so real self-care is about making those choices aligned

with what you actually care about. And the key there is then that's usually hard and it does not

take away suffering in the way that hedonic well-being can.

Right. You did mention this in the book and I highlighted this part because I thought this

was something that was important, particularly in bridging this tension that I feel with self-care,

which that it is homogenizing, right? It does not account for the fact that for some people,

just by virtue of who they are born in this world, there will be a degree of suffering

for them. There will be great joy to all lives. No life is all suffering. But one of the things

that I struggle with with self-care is that it says that if you have any suffering, you've somehow

failed at self-care. But for some of us, our life will be just by virtue of who we are. If you are

born queer in this world, in some parts of this world, there will be some suffering visited upon

you because of who you are. If you are born disabled into an able-centered world, there

will be a certain degree of friction. There will be friction for you based on who you are. And I

think something I struggle with with self-care is the way it blames a person for the suffering

that is just part of being a human being for some of us. And you're saying that there is a

version of the self-care that you can embrace that suffering and move through it anyway.

Yes. You can acknowledge it and name it and take comfort and have your real self-care life rafts

to understand what that comfort is and still keep going when you're ready. So I think that's

the other piece here is that there's four principles. Principles are fairly simple,

but they're not easy. This is not the type of thing where you read this book and you're like,

oh, I got it, great puja. This is years and years of work and it doesn't end either, I will say.

I've been open on Instagram about how after this book launch, I burnt out. I wrote the book Real

Self-Care and then I promptly burnt out. Launching a book would do that too.

Which I've come to conceptualize that in my own therapy with my psychoanalyst as

it's because I've been interfacing with this very difficult system, which is the American

media economy. And in every season of your life, you have to relearn what your values are and it's

always shifting. So I see that actually as an optimistic message in that this isn't something

that you win at. It's something that you're constantly sort of practicing because we're

all changing. We're always growing. I think on that specific topic though of suffering and how

certain people suffer more in America than others, I think that's just such an important

piece of this whole conversation. And that's why with the fourth principle of power,

it's like you need to know when based on what privilege you have, ways in which you've been

oppressed, whether you should be or whether you want to be receiving help or giving help.

Are you taking or are you giving? That depends on your identity. That depends on

what's going on in the world. It's not static, it's dynamic, but that's a piece of this conversation

that I hope is constantly threaded through. And I share examples of patients in my practice who

have stepped off the conveyor belt of the consumer-oriented faux self-care and started setting

the boundaries and understanding their values and which led to changes either in their employer

workplace or in their family system. My thesis though about this as a psychiatrist is that

people are more motivated to change when they're doing it because it benefits them.

And I know that's just a very pessimistic view of the world.

It is a view on human nature. It's not untrue.

I mean, and to be fair, most of the people who come to see me are struggling with anxiety,

depressed. So there's significant struggles. So you're trying to relieve these struggles

and you're making changes, personal changes, to relieve that suffering. But when it can be done

in this framework of asking for what you need, speaking to yourself with compassion,

understanding what really matters, then we at least have a chance of getting to collective

action because you're modeling to your coworkers. You're asking for what you need from your employer

as opposed to staying stuck in that commodified version.

You never get over the hump when you're there. It's what you're saying.

Yeah. Yeah.

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I play Wordle in spelling bee every single day.

That's the first thing I do. Play Wordle while making coffee.

I pour myself a cup and do the crossword, which is the jewel of my morning.

I started Wordle 194 days ago and I haven't missed a day.

So what's our starting word today?

I think it should be ocean.

Storm is a good one.

Brisk because it's a brisk day outside.

At this point, I'm probably more consistent with doing the crossword than brushing my teeth.

I don't think there's a day that I've missed it.

I'm definitely a Monday or Tuesday player right now,

but I aspire to do Friday and Saturday puzzles.

I have seen you do spelling bee during meetings when you're supposed to be paying.

That never happens.

When you win a puzzle, where you get that you're a genius,

I always take a screenshot and send it to my wife.

The New York Times crossword.

It really is a moment of zen that cleanses my brain.

I wish the days were shorter and that the wordles were longer.

Join us and play All New York Times games at nytimes.com slash games.

So let's talk about your practical tools.

You've laid out these four pillars.

Again, I want to warn everybody these are tough as somebody who's dabbled in each.

They are tough, but let's start with boundary setting.

It is my favorite one by the way.

I love boundaries the way I love getting extractions when I get a facial.

They hurt in the best way possible.

You got to do them.

I'm not sure anybody ever loves them, but you love having had them done.

So let's talk about boundaries.

How do you define them?

Because you define them in a very particular kind of way.

I imagine you to be somebody who's very good at boundaries, trust me.

I had to learn.

If I'm good at them, it's because it didn't come naturally at all.

Yeah, so I like you was never terribly good at boundaries.

And the story that I tell in the book was after I graduated residency,

and I was coming on the faculty at GW, George Washington University in DC.

And I'd just gotten my dream job.

It was a faculty position.

I was going to be supervising in our women's mental health clinic.

I was like this very green, bright-eyed, bushy-tailed little dude I know.

But my mentor took me out for lunch on my first day and she gave me this piece of advice.

She said, Pooja, you don't need to answer your phone.

You can let it go to voicemail, listen to what they want, and then decide how to respond.

And that was just mind-boggling to me because I had just finished medical school and residency.

And in those days, you had the pagers.

Your pager would go off and it was got to respond right away.

And here was my mentor being like, no, you'll just listen to the voicemail.

And that was an aha for me because I realized, oh, the boundary is the pause.

And then you always have three options.

Yes, no, or negotiate.

So sometimes it was like the front desk and they just had a bunch of paperwork for me to sign.

And I could say, oh, I'll come around at the end of the day after I'm done.

Or it's a patient who I know if she misses one day of her stimulant,

her ADHD is so bad that she could literally lose her job or get in a car accident.

I'm going to put in that refill.

The pause is when I exert my decision-making.

And that was eye-opening to me because the reality is that no isn't always accessible.

And no always comes with a cost, always.

And the lower you are in the cast system, the more cost there is.

And so the reality is many folks can't say no.

But you can always pause and you can think through these three options.

And then if you find yourself in a situation where you're like,

I want to say no, but I can't because I might lose my job or whatever reason,

then you bookmark that for yourself.

And you say, okay, one of my real self-care goals,

or one of the things I want to think about is a year from now,

I want to be able to be closer to saying no than I am now.

Okay, so see, I like this moment because I have young women who come to me in the profession,

like I'm sure you do, and they want to talk to me about their career path and trajectory,

especially when they are women of color, first generation, immigrant women,

any woman for whom this life has not basically been foretold for them, right?

And I say to them, saying no for you, as you just said, will always come at a cost.

And that flies in the face of every bit of feminist girl power advice they've ever been given

about negotiating salary and negotiating time off and being a CEO and all of that kind of stuff,

where I say no, you can't get away with that, right?

There are negative consequences with being interpreted as being bossy,

and I'm using the kind to be word.

I think we know the unkind to be word,

but when it feeds into stereotypes of being angry, being foreboding,

that comes with a social cost.

And I say to them, it isn't that you shouldn't say no,

but that there is a certain power in knowing what the cost is of your no.

That's all.

Just know the moments when you wish you could have said no,

and I think you've even said it even better here.

Maybe you can't say no, but at least now you're saying,

you go, now you've got a new goal.

Maybe in two years, the next time I have this pause, I want to be able to say no.

Yes.

That seems better to me than just feeling powerless.

Right.

Well, because you've verbalized it for yourself,

and there's a clarity and an honesty of truth so that the no has a cost.

It always has a cost.

And if we're talking about personal life and family situations,

there's all sorts of drama that comes with no, right?

That's right.

And not everybody is able to, you decide,

am I going to put up with the drama, or am I going to say no?

You can't have both.

And I think this is the thing about self-care is just usually packaged for us,

that there is a way to have boundaries and have everybody like them.

That's a fairy tale, is it not?

It's a fantasy.

And I think if we say like, why do we all think that?

Who's to blame?

Like certainly what you were speaking about earlier with sort of influence or culture,

wellness, self-help, speak of like as if there's some shortcut,

like as if there's some way to live your life where you can just sort of pretend that none

of this messiness exists and you can just life hack your way, self-help your way.

Life hack, the life hack.

Okay.

I also have beef with the life hack.

Yes.

Because so often, seriously, the life hack is just basically be,

be more popular, be wealthier, and be more impervious to consequences.

Yeah, sure.

That's a great life hack, but it's not accessible to all of us.

Exactly.

Yeah.

It goes back to me to this history of deep in the self-help culture comes out of this genre

or subgenre book of the leadership book, that you can create a win-win for everybody.

But in real life, it seems to me, things are messier.

Sometimes there isn't a win-win.

I think especially in family situations, you've got an example in a book where it is a new

young mother where she's trying to protect her child from the grandparents coming over,

the baby's sick.

There isn't a win-win, right?

There is just a no.

But we've gotten that our culture, this idea that there's a boundary you can exert

where both sides will feel like they won something.

And if you couldn't find that win-win, that somehow you failed as a person.

And I think that's pretty insidious, especially to put that on women who I just don't think we,

the choices available to us just rarely give us a win-win.

I completely agree.

And I think that just going back to sort of the facade that's put up,

that there can be this win-win, I think that that it's a gendered facade.

Because ultimately, women in most families are the holders of all of that messy emotion.

When there's a consequence, when mother-in-law is angry,

it's the wife who bears the brunt of that.

Right.

What I often tell my patients is when it comes to boundaries in family settings,

is you have to understand that there's two distinct processes.

There's the very technical, operational bit of communicating the boundary,

like making the decision, doing the calculus in your mind,

and then saying, unfortunately, we're not going to be coming for Thanksgiving this year,

delivering that.

And then the other side, that the separate process is the feelings

and the backlash that's going to come, the guilt that you're going to feel.

And the crux is that the person you're setting the boundary with

cannot make you feel better.

They can't take care of your feelings.

If you keep going back to them to try and feel better, that doesn't work.

You need a third party, whether it's a friend, a therapist, a coach,

you need a third party to process those feelings with.

And then you have to trust that the relationship can withstand this tension,

and then there could be a repair.

Oh, I am totally guilty of trying to get the person to fix it for me.

I want them to accept that the boundary was OK.

Right.

You want them to say, it's OK, trustee.

I understand.

I love you.

Yep.

And they probably will, just not right now.

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OK.

Tell me about the glass and rubber balls.

So the second principle of real self care is compassion, which I think about compassion

based off of Kristen Neff's, where Kristen Neff is a psychologist who's

done a ton of research on self compassion.

And it's basically like looking at the way that you talk to yourself,

like the conversations we all have in our minds.

It might not be actual words.

Sometimes it's just like images or associations.

Women in particular are really, really mean to themselves.

Mm-hmm.

There's a statistic in the book from a survey from Weight Watchers that found that

more than 50% of women say they have days where they speak critically to themselves all day.

So what I'm talking about with self compassion is that we look at the conversations we have

with ourselves and basically just like be nice, you know, like be nice to yourself.

Like stop being such a jerk to yourself.

And in that kind of section of sharing how to do that, I talk about this situation where

if you're a caregiver, maybe of elderly parents, of little kids, it's not uncommon

for a patient to come in my practice and just be like, Dr. Leshman,

like everything's a priority.

You know, like there's nothing that can give here.

Like how am I supposed to know how to fix any of these things or to feel like I have the space

to even like to even read your book, you know, like how do I have the time for any of this?

And so I thought of this quote, you need to know which of the balls that you're juggling

are glass and which are rubber.

And so often for my patients, everything feels like glass.

And so what I say is that when everything feels like a glass ball,

that means your body is in fight or flight.

You are at max capacity and your prefrontal cortex cannot solution or problem solve.

So you can't actually make larger strategic decisions when everything feels like a glass ball.

You have to remove yourself from the situation.

Even if it's just like shutting down your laptop, leaving your office, go for a walk,

delete Instagram, like whatever you need to do, you have to step away

and let yourself get to a place where you can actually feel like you can actually feel.

And then make decisions from there, like allow yourself then to come back to, okay,

here's the to-do list, which of these things can be rubber.

I just want to also kind of call out to like, this is, you know, our to-do lists are like,

they're just delusional, like literally delusional.

Like, and I include myself in this.

Because I was feeling pretty personal.

I'm glad you included yourself.

No, I include, like there's some mornings, I'm like, I have 10 things on this list.

Like there's no way.

You really can only have two, maybe two max priorities for a day.

Lots of people talk about this.

And so that's not anything new, but it's more about like, when you decide,

you have to step out of that panic, fight or flight mode.

So many of my patients are just constantly in that place.

And I guess, again, you know, it's not our fault.

Like there's structural reasons why.

Yeah. Speaking of structural reasons, the next pillar seemed to be the one most directly tied

to sort of the structural stuff for me.

And that is the pillar where you say, align your values with your behavior.

This is the one in me where it's me, there seemed to just be a concrete wall.

What does it mean to align your values with your behavior?

And can we get real with just how hard that is?

I don't think that it always needs to be something that, like,

nobody should look at this and feel like they need to take on something

that is larger than right sized for them.

For example, I had a patient who took a leave of absence for her mental health.

She was caring for her elderly father and facing other stressors.

And through that leave of absence advocated for herself, set boundaries with her family.

Ultimately, when she came back, you know, she had been very worried that she would be penalized.

Instead, her employer was actually responded positively,

which of course is an exceptional circumstance.

I have a situation with a patient right now without giving too much away,

where it's a little bit different.

Where it's like they're really looking at the type of life they want to be living

in raising their kids and how much money they need.

And through this process, they're thinking about real self-care.

They decided to move to a less posh neighborhood, downsize their house,

so that they could be in an environment that felt more authentic to them.

That did require that their kids are moving schools.

That's a sacrifice, right?

Like that's a big ask.

That's a big thing.

And by making this shift, they are signaling to their kids that our value is not unchecked

consumerism, right?

Our value is community to live in a space where we have neighbors,

where we go over to each other's houses, we hang out.

That's another version of real self-care.

I get that there is a link between individual actions and ultimate collective action,

but the link is pretty murky.

And you can do all of that and it not lead to that sort of collective action,

especially if there isn't some explicit effort to link it up with other people's individual action.

You can imagine a scenario where you do, where a family, one family does that,

but it again doesn't start a chain reaction because they don't link to other families,

right?

And that doesn't sort of become a sort of collective action.

And so I do worry about feeling that individual responsibility and that the people who will

feel individually responsible are those people who were already predisposed for feeling responsible.

And the people who weren't are just going to kind of do it and not sort of link it to

collective action and we kind of find ourselves back in the faux self-care

loop again, right?

With it not spreading to others, which I think is the ultimate solution for all of us.

We need more of this for more people, more of this for more of us.

My take is that if we stay on the level of a bubble bath, then there's no chance.

Fair.

For sure.

Yeah.

But if we move to a level deeper and some portion of our society continues to understand that

real self-care is about community, not consumerism.

That it will at least have a chance of moving us towards change.

Again, I'm not Pollyanna about this though.

I said earlier that I think the best way to motivate folks to progressive action is to serve

self-interest.

So, I don't think that it's definitely not like a one-to-one type thing, but I think it's

better than the alternative.

But I think it's a valid question.

It's also the reason why I'm a psychiatrist and not a sociologist or an economist.

Fair.

Well, definitely don't be an economist and maybe even don't be a sociologist.

We probably have enough of both.

I will say one thing that I've been thinking about is, because I talk about the dialectic,

right?

And you talk about the dialectic too in your work in thick.

And I love the way that you described it as a dance, where you're constantly moving back

and forth.

And of course, you conceptualize it in terms of race.

But I'm thinking of it here as we're always going back and forth between the individual

and the social.

And the two are always in this dance where both are true.

I think both are true that the government is responsible for enacting top-down solutions.

And individuals do have agency to make choices in their lives that can protect them and buffer

them and also spur potential change.

And maybe it is more hopeful than the reality.

I'm not sure.

But I think that's also part of why I'm doing the work that I'm doing.

I often have patients who like in the depths of burnout, they'll kind of come to this and

sort of be like, okay, well, what's the right decision?

Should I do this job or that job?

Or is it that guy or this guy?

And I think when you're in that space, it's so important to understand that it's not one

decision.

There's never one choice.

It's actually hundreds and thousands of small choices that get you to the place.

Because the place, you don't even actually know what the place is.

So you just have to keep doing the small things, the moving to the different neighborhood,

the making the small tweaks in your professional life.

And for me, I find that I go through that cycle probably every six months, not moving.

Thankfully not moving.

But especially in terms of work, having to re-litigate my boundaries and what my value,

like the shifting sort of priorities is always changing.

That is an excellent, just rough at least rule of time.

I find that helpful to know, because that is something I struggle with,

how often should I revisit this?

So a nice time horizon is nice.

Like, hey, it's been about a year since I've checked in with myself here on what I believe.

Do I still believe that?

Should this still be guiding my decision making?

Those are the types of questions that shouldn't be written in stone is what I think you're saying.

And it is nice to know, hey, every six months to a year, it's worth re-asking.

Yeah. And that's a place where you can really look at, like you can use those values words

and tie them to professional relationships, professional achievements and accomplishments

and kind of think about, even in those six months, what am I most proud of?

And why am I most proud of it?

So it's not like a checklist, like a goal type of thing.

It's much more about the quality of what you engaged in, how you showed up, why it matters

and moving kind of from that place.

Now we ask all of our guests for three book recommendations.

You have three books you think we should read?

I do. So the first two are current books.

And then the last one is a little bit of a classic.

The first book is called Living Resistance by Caitlyn Curtis.

Caitlyn is an Indigenous poet and author.

I got to know her during my book launch.

Her book came out around the same time and we become friends.

Living Resistance is just, it's beautiful.

It's the type of book that you have by your bedside and you read a chapter before you go

to bed and then you wake up the next morning and you feel a little different,

just a little bit more connected to yourself.

She talks about these four different realms, the communal, the spiritual, the ancestral,

the personal, love it, Living Resistance, Caitlyn Curtis.

The second is by Lisa D'Amour, the emotional lives of teenagers.

Lisa is a clinical psychologist.

She's a friend.

I know she's been on the show and this book has been everywhere and she's awesome.

The reason that I mention it is because it's a great book for anybody who's parenting,

teen kids or even little kids.

My son is 15 months and so I have a long way to go.

But I'm thinking a lot in terms of how do we support our teens when we're talking about mental

health and we're talking about real self-care, how do we bring this into the next generation?

And then my third, N.K. Jemisin, the fifth season, I learned so much about oppression,

colonialism, capitalism through her world building because you see it in the characters.

And she does a brilliant job of describing trauma in her female protagonists.

This is sci-fi fantasy, but if there's any folks out there like me who, for whom,

sci-fi fantasy is a little bit of self-care, then you'll love this if you haven't checked it out yet.

Lucia, thank you so much.

Thank you.

It was such a pleasure, Tressie.

This episode of the Ezra Klein Show was produced by Kristen Lin, fact-checking by Michelle Harris.

Our senior engineer is Jeff Geld.

Our senior editor is Annie Roe Strosser.

The show's production team also includes Emma Fagabou and Roland Hoot.

Original music by Isaac Jones.

Audience strategy by Christina Samueluski and Shannon Busta.

The executive producer of New York Times' opinion audio is Annie Roe Strosser.

And special thanks to Sonia Herrero.

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