Why self-care urgently needs a revamp

Here’s a scenario from my clinical practice as a psychiatrist specializing in women’s mental health that happens often: A patient laments that she finally worked up the nerve to take the afternoon off work, only to spend the whole afternoon feeling guilty about her leftover to-do-list, and the emails that went unanswered. She even scheduled herself a “treat yourself” massage, but spent the whole massage ruminating on how she would have to make up for her lost productivity tomorrow. 

Sound familiar? I’m a board-certified psychiatrist and the founder and CEO of the women’s mental health community, Gemma, and these are the types of problems I hear about all of the time. 

We all know that wellness is broken – a bubble bath and a glass of wine are not going to fix the huge social problems that we are all facing globally – whether that is income inequity, climate change, or how because of a global pandemic, women have been set back decades in terms of gender progress. 

In my new book REAL SELF-CARE, I propose a solution. Self-care is not a product to buy or even a task to check off the list. Real self-care is an internal decision-making process. It’s about how we choose to spend our time and our energy. It’s something we embody, not something to accomplish. Real self-care is a verb, not a noun. 

Take my patient Shalini – she knew that going for a weekly swim was profoundly nourishing for her, physically and mentally. So, she reorganized her entire work schedule and lifestyle so that she could make it to the pool 2 times a week. The commodified, consumeristic version of self-care (what I identify as Faux Self-Care) would say that swimming was self-care. 

I’m proposing something more radical. For Shalini, real self-care was the internal decision-making work she did to identify that swimming was important to her, the boundaries she set with her partner and work so she could get to the pool every week, the compassion to gave to herself, and the cognitive work she did to build her schedule this way. The decision-making process, which was aligned with her values, and unique to Shalini’s circumstances, was real self-care. 

What I’m talking about here is the distinction between methods and principles. Methods are operational, they work for a circumscribed situation. Principles, however, are universal and take into account perspective. In my conceptualization of real self-care, I use this framework because I find that in my clinical practice and at Gemma, many women notice that the self-care methods that worked in their 20s or early 30s, no longer hold up later in life, when they have less discretionary time due to raising a family or career pressures. 

Instead of thinking of self-care as something discrete that you accomplish, and check off a list, I’m redefining it to be threaded inside every decision that we make. Real self-care is an internal decision-making process that can be layered into everything you do. 

And here’s why this is so critical. I’ve written before about how burnout is a symptom of social betrayal, and that instead of placing the burden on individuals to “be well,” we need to be fixing the root cause of our problems – the collective social systems that cause us to feel fatigued and hopeless in the first place. 


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