Boundaries, Burnout and the 'Goopification' of Self-Care

Love it or hate it, self-care has transformed from a radical feminist concept into a multibillion-dollar industry. But the wellness boom doesn’t seem to be making a dent in Americans’ stress levels. In 2021, 34 percent of women reported feeling burned out at work, along with 26 percent of men. Dr. Pooja Lakshmin, a psychiatrist, has observed how wellness culture fails her patients, who she says are often burned out because of systemic failures, from the stresses that come with financial precariousness to the lack of paid family leave. In her book “Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included),” she encourages people to look beyond superficial fixes — the latest juice cleanses, yoga workshops, luxury bamboo sheets — to feel better. Instead, she argues that real self-care requires embracing 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 real self-care, you not only take care of yourself, but you can also plant the seeds for change in your community. In this conversation, the guest host, Tressie McMillan Cottom, and Lakshmin discuss how the pandemic opened up a larger conversation about parental burnout; how countries with more robust social safety nets frame care as a right, not a benefit; why it’s fair to understand burnout as a type of societal “betrayal”; how to practice boundary-setting and why it can feel uncomfortable to do so; the convenient allure of “faux self-care”; and more. This episode was hosted by Tressie McMillan Cottom, a columnist for Times Opinion, a professor at the University of North Carolina, Chapel Hill, and the author of “Thick: And Other Essays.” Cottom also writes a newsletter for Times Opinion that offers a sociologist’s perspective on culture, politics and the economics of our everyday lives. Mentioned: More information about Ezra’s Jefferson Memorial Lecture “We Don’t Need Self-Care; We Need Boundaries” by Pooja Lakshmin “How Society Has Turned Its Back on Mothers” by Pooja Lakshmin “Our Obsession With Wellness Is Hurting Teens — and Adults” by The Ezra Klein Show with Lisa Damour “A Legendary World Builder on Multiverses, Revolution and the ‘Souls’ of Cities” by The Ezra Klein Show with N. K. Jemisin Book Recommendations: Living Resistance by Kaitlin B. Curtice The Emotional Lives of Teenagers by Lisa Damour The Fifth Season by N. K. Jemisin Thoughts? Guest suggestions? Email us at [email protected]. You can find transcripts (posted midday) and more episodes of “The Ezra Klein Show” at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs. This episode of “The Ezra Klein Show” was produced by Kristin Lin. Fact-checking by Michelle Harris. The senior engineer is Jeff Geld. The senior editor is Annie-Rose Strasser. The show’s production team includes Emefa Agawu and Rollin Hu. Original music by Isaac Jones. Audience strategy by Kristina Samulewski and Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. Special thanks to Sonia Herrero.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Ezra Klein?

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

• 0:16Ezra Klein?

  Hey, it is Ezra. I am on book leave this week, but we have the great Tracy McMillan Cotum 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, in 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.

• 0:47Ezra Klein?

  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 calperformances.org. We'll put the link to the event page in show notes. Again, that is October 5th at UC Berkeley.

• 1:31Speaker 01

  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

• 2:15Speaker 01

  just another productivity chore, the kind that led us to burnout in the first place.

• 2:24Speaker 01

  Pooja Lakshmi 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. Lakshmi 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 Lakshmi onto the show to discuss why the easy,

• 3:09Speaker 01

  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 ezra kline show at nytimes.com.

• 3:39Speaker 01

  Welcome to the show, Pooja Lakshmi. How are you today?

• 3:42Speaker 02

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

• 3:46Speaker 01

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

• 4:05Speaker 02

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

• 4:09Speaker 01

  Okay.

• 4:12Speaker 01

  All right, so it's not just me?

• 4:13Speaker 02

  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.

• 4:33Speaker 01

  Yeah, it sometimes borders 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.

• 4:49Speaker 01

  Of self-care-ness. I think the sort of groupification 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.

• 5:34Speaker 01

  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.

• 6:17Speaker 02

  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 eutomonia, you know, psychological flexibility, and, you know, everyone's like, that's not a book title.

• 6:43Speaker 02

  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 a meritocracy in America, that, 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,

• 7:28Speaker 02

  affordable, equitable health insurance, et cetera. 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 any different-

• 8:10Speaker 01

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

• 8:17Speaker 02

  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.

• 8:42Speaker 01

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

• 8:48Speaker 02

  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

• 9:31Speaker 02

  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 a baby or had one themselves, you know, like, how am I supposed to do that? 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

• 10:15Speaker 02

  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 childcare 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

• 10:59Speaker 02

  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-

• 11:22Speaker 02

  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.

• 11:50Speaker 01

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

• 12:33Speaker 01

  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?

• 12:55Speaker 02

  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

• 13:20Speaker 02

  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,

• 14:03Speaker 02

  "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 US, when someone gets maybe just like

• 14:48Speaker 02

  four weeks of leave from their employer, it's a benefit. But the difference in that, right? Who's responsible for taking care of that caregiver? In the US, it's always up to us. And then even when everything falls apart, it's our fault.

• 15:04Speaker 01

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

• 15:14Speaker 02

  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.

• 15:38Speaker 02

  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 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?

• 16:23Speaker 02

  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, you know, the work of Audre Lorde, bell hooks. Oh, yeah. Black queer thinkers, like that's not an accident at all that those were the folks

• 17:07Speaker 02

  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 Audre Lorde said, and there is a survival aspect to it. And one last thing I want to say, just as we're sort of diving into this.

• 17:51Speaker 02

  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

• 18:34Speaker 02

  as to how you make decisions in your life and then seeing how that impacts other people as well.

• 18:41Speaker 01

  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?

• 19:09Speaker 02

  Please.

• 19:09Speaker 01

  Um, 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? You know? 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.

• 19:50Speaker 01

  I was standing in the Williams Sonoma a few weeks ago. And, you know, Williams 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 scents. 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 Williams Sonoma orange essence, something or the other candles.

• 20:34Speaker 01

  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,

• 21:15Speaker 01

  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, hunky-dory about my...

• 21:44Speaker 01

  Aligning with my principles right now. Pooja, I'm not feeling overjoyed.

• 21:52Speaker 02

  Do you want my Dr. Lachman response? Or do you want my Pooja response? Or do you want both?

• 21:57Speaker 01

  I would like both.

• 22:00Speaker 02

  OK, let me start with Dr. Lachman. Everything that you're describing sounds completely reasonable and normal because you're in the hard part of the transition.

• 22:11Speaker 01

  OK.

• 22:11Speaker 02

  Like, you're in the work. You're still in that space where you made those big decisions. And it takes time, right? To like 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 like, 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 sort of where you live, like what your space is like, your physical space.

• 22:54Speaker 01

  I do, right.

• 22:55Speaker 02

  So you're in that phase right now where you're having to curate that. It's a different physical space. So your nervous system, your brain, your body is doing a lot of what I call back of house work, sort of unconscious work of like, 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.

• 23:35Speaker 01

  So doing the right thing doesn't always feel.

• 23:40Speaker 01

  Good. Immediately.

• 23:43Speaker 02

  Correct. And that's an important point because the whole concept of real self-care is based on this term eudemonic well-being.

• 23:53Speaker 01

  Right.

• 23:53Speaker 02

  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 eudemonic 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,

• 24:33Speaker 02

  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.

• 25:00Speaker 01

  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, too, 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.

• 25:43Speaker 01

  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-sentient world, right? 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?

• 26:19Speaker 02

  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.

• 26:44Speaker 01

  Not easy, no.

• 26:45Speaker 02

  This is not like the type of thing where you read this book and you're like, all right, got it, great pooja. Like, no, this is like years and years of work and it doesn't end either, I will say. You know, 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.

• 27:06Speaker 01

  Launching a book would do that to you?

• 27:09Speaker 02

  Which, you know, I've come to conceptualize that in my own therapy with my psychoanalysts 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 like 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

• 27:51Speaker 02

  more in America than others, I think that's just such an important piece of this whole conversation. And, 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.

• 28:20Speaker 02

  Are you taking or are you giving?

• 28:23Speaker 02

  That depends on your identity. That depends on temporally 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.

• 29:02Speaker 02

  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.

• 29:16Speaker 02

  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, right? So there, you know, 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

• 30:01Speaker 02

  version. You never get over the hump when you're there, is what you're saying. Yeah, yeah.

• 30:32Speaker 01

  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 gotta do them. I'm not sure anybody ever loves them, but you love having had them done. You know? So let's talk about boundaries. How do you define them? Because you define them in a very particular kind of way.

• 31:14Speaker 02

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

• 31:18Speaker 01

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

• 31:22Speaker 02

  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, you know, bright eyed, bushy tailed. A little did 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.

• 32:06Speaker 02

  And that was just like mind boggling to me because I had, you know, just finished medical school and residency. And in those days, you had the pagers, you know, your pager would go off and it was like, you gotta respond right away. And here was my mentor being like, no, you don't, you'll just listen to the voicemail. And that was like an aha for me because I realized, oh, the, 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, you know, it's a patient who I know if she misses one day of her stimulant, her ADHD is so bad that she could like literally lose her job or get in a car accident. I'm going to put in that refill.

• 32:50Speaker 02

  The pause is when I exert my decision making. And that was like 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 caste system, the more cost there is.

• 33:11Speaker 01

  Exactly.

• 33:12Speaker 02

  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 really, I want to say no, but I can't because I might lose my job or, you know, whatever reason, then you bookmark that for yourself and you say, okay, one of my real self-care goals or, you know, 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.

• 33:44Speaker 01

  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, you know, 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 she-CEO and all of that kind of stuff.

• 34:29Speaker 01

  Where I say, no, you can't get away with that, right? There are negative consequences with being interpreted as being bossy.

• 34:40Speaker 01

  And I'm using the kind B word. I think we know the unkind B 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.

• 35:24Speaker 02

  Yes.

• 35:25Speaker 01

  That seems better to me than just feeling powerless.

• 35:31Speaker 02

  Right. Well, because you've verbalized it for yourself and there's a clarity and an honesty, a truth. So 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?

• 35:51Speaker 01

  That's right.

• 35:52Speaker 02

  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.

• 36:00Speaker 01

  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?

• 36:12Speaker 02

  It's a fantasy. And I think, you know, 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 influencer 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.

• 36:39Speaker 01

  The 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, you know, and that, you know, 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.

• 37:22Speaker 01

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

• 38:01Speaker 02

  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.

• 38:14Speaker 01

  Hmm.

• 38:15Speaker 02

  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.

• 38:31Speaker 01

  Right.

• 38:31Speaker 02

  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.

• 38:52Speaker 01

  Woo!

• 38:53Speaker 02

  Right? And then the other side, that's a 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.

• 39:10Speaker 02

  Like, 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.

• 39:34Speaker 01

  Oh, I'm totally guilty of trying to get the person to fix it for me. I want them to accept that the boundary was OK.

• 39:41Speaker 02

  Right, you want them to say, "It's OK, trusty. I understand. I love you."

• 39:45Speaker 01

  Yep.

• 39:45Speaker 02

  And they probably will, just not right now.

• 39:48Speaker 01

  Got it.

• 40:12Speaker 01

  OK, tell me about the glass and rubber balls.

• 40:15Speaker 02

  So the second principle of real self-care is compassion, which I think about compassion based off of Kristin Neff's, where Kristin 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. There's a statistic in the book from a survey from Weight Watchers that found that more than 50% of women

• 40:59Speaker 02

  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...

• 41:30Speaker 02

  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. Lexman, 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?

• 41:56Speaker 01

  Mm-hmm.

• 41:56Speaker 02

  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.

• 42:39Speaker 02

  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, you know, 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.

• 43:24Speaker 01

  Because I was feeling pretty personal. I'm glad you included yourself.

• 43:28Speaker 02

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

• 43:33Speaker 01

  Yeah.

• 43:34Speaker 02

  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.

• 43:57Speaker 01

  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 to me where it's me, there seems 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?

• 44:19Speaker 02

  I don't think that it always needs to be something that, um, 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'd 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, a situation with a patient right now, without giving too much away, where

• 45:02Speaker 02

  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.

• 45:34Speaker 01

  Uh huh.

• 45:34Speaker 02

  That's a sacrifice, right? Like, that's a big ask. That's a big thing. And by making this shift, they are signaling.

• 45:45Speaker 02

  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.

• 46:03Speaker 01

  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.

• 46:47Speaker 01

  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 gonna 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.

• 47:26Speaker 02

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

• 47:32Speaker 01

  Fair.

• 47:33Speaker 02

  For sure.

• 47:34Speaker 01

  Yeah.

• 47:35Speaker 02

  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.

• 47:54Speaker 02

  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, you know, it's definitely not like a one-to-one type thing, but I think it's better than the alternative. But, you know, I think it's, I think it's a valid question. It's, 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.

• 48:38Speaker 02

  I, I will say like, one thing that I've been thinking about is, you know, 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, this dance where both are true.

• 49:16Speaker 02

  I, 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?

• 50:01Speaker 02

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

• 50:24Speaker 02

  So you just have to keep doing the small things, the moving to the different neighborhood, you know, the making the small tweaks in your professional life. And for me, I find that I go through that cycle probably like every six months, not moving, thankfully. Thankfully, not moving. But especially in terms of work, having to relitigate my boundaries and where my, what my value, like the shifting sort of priorities is always changing.

• 50:51Speaker 01

  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? You know, am I, 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.

• 51:29Speaker 02

  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.

• 52:02Speaker 01

  Now, we ask all of our guests for three book recommendations. You have three books you think we should read?

• 52:11Speaker 02

  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 Kaitlin Curtis. Kaitlin 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've become friends. Living Resistance is, it's 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.

• 52:53Speaker 02

  Living Resistance, Caitlin Curtis. The second is by Lisa Demore, The Emotional Lives of Teenagers. Lisa's 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 like, how do we support our teens when we're talking about mental health and we're talking about like, real self-care? Like, how do we bring this into the next generation? And then my third, NK Jemison, The Fifth Season.

• 53:36Speaker 02

  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 about, 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.

• 54:04Speaker 01

  Usha, thank you so much.

• 54:06Speaker 02

  Thank you. It was such a pleasure, Tracy.

• 54:19Speaker 01

  This episode of The Ezra Klein Show was produced by Kristin Lynn. Fact-checking by Michelle Harris. Our senior engineer is Jeff Geld. Our senior editor is Annie Rose Strasser. The show's production team also includes Emma Fagabu and Roland Hu.

• 54:36Speaker 01

  Original music by Isaac Jones. Audience strategy by Christina Samulowsky and Shannon Busta. The executive producer of New York Times Opinion Audio is Annie Rose Strasser. And special thanks to Sonia Herrera.