Emily Oster:

I’m Emily Oster. This is ParentData, and today I’m talking to Pooja Lakshmin about her new book, Real Self-Care. When we hear the phrase self-care as parents and especially as moms, I think what comes to mind is taking an hour to have a massage or lay in a bath. And the wellness industry, the world, has somehow convinced us that both, that should be enough to take care of ourselves and also that it’s, to some extent, a bit selfish. How could you possibly take an hour away just to lay around in a bath or, God forbid, to use the bathroom in quiet peace. Is that self-care, pooping alone?

Pooja Lakshmin:

Yeah, absolutely. Well, first of all, I’m excited to be here. I am Dr. Pooja Lakshmin. I am a board certified psychiatrist and the author of the book Real Self-Care, which just came out, and I’m a mom of a, gosh, almost 16 month old at the time of this recording.

Emily Oster:

Time goes fast. My kids are 12 and eight, so I feel like I know what it’s like to be there, but you rapidly forget.

Pooja Lakshmin:

Yes.

Emily Oster:

So we’re going to talk about your book. I don’t like the phrase self-care in general. I don’t like it in the context of parenting. I don’t like it in the context of being a mom, but 20% of women are diagnosed with postpartum depression. That surely understates the true burden. And throughout the life cycle, from the beginning, from when our kids are older, there is this incredibly hefty care burden which more often falls on moms. I wrote something a few months ago about a study which basically just proved what we already know, which is schools always call mom rather than dad. And so these care burdens, the household labor burdens, the invisible work burdens, however you want to call them, fall disproportionately on women. They also fall on men. They fall on all parents. And in the past several years, I actually think there’s been more recognition of a lot of these things. More recognition of the disparities in these burdens, more recognition of things like postpartum depression. But when people recognize this, there is then a lot of discussion of self-care and the way to address this. One important way to address this is to engage in self-care. And on Instagram, self-care is like a spa day. Make sure you’re taking care of yourself and taking a spa day, getting a manicure, get a scented candle. It could have this kind of scent. But your book is titled Real Self Care, and so is real self-care finding the right scent for your candle?

Pooja Lakshmin:

I think my answer to this.

Emily Oster:

It’s mint is your answer. If you get the correct mint from the Yankee Candle store, you’re good.

Pooja Lakshmin:

You’ll be good to go. You’re like-

Emily Oster:

It’s totally fine.

Pooja Lakshmin:

So the sub-subtitle of the book is Crystals Cleanses and Bubble Baths not included. And I actually kind of pushed hard with my publisher because it makes it a really long title, which is not great for media, they don’t love that. But I was like, “No, this is really important,” because this book is basically a culmination of a decade of professional and personal experience in my own life of the ways in which woo woo wellness fails us. I spend a lot of time upfront in the book talking about how the real problem is our social structures. I wrote a piece for the New York Times back in 2021, so height of the pandemic called This is Betrayal, not Burnout, talking about moms who work outside the home and how really it’s about public policy, it’s about paid leave, it’s about affordable childcare, access to good health insurance.

Emily Oster:

Yeah. I mean it’s interesting. I think that there’s this distinction between immediate, so some combination of immediacy and short-term ness that feels very seductive in the self-care space. I could get it right now. It would be easy to do. I could do it once. I could go get this massage. I could get these pills that are supposed to relax me or whatever. And that in fact, having a structure in your life, having put in time, which, to be fair, we may not have, but the value of putting in time to think about how to structure your life so it doesn’t feel like “God, if only I had some pills to fix how terrible I feel.”

Pooja Lakshmin:

And I should say I prescribe antidepressants all the time. I actually take antidepressants. This isn’t like anti med.

Emily Oster:

No, no. When I said don’t take pills, I just meant like a supplement that says it’s going to give you some kind of woo woo happiness, not antidepressants, which I think are great.

Pooja Lakshmin:

Yes. So my conceptualization of boundaries is a little bit different than what you might hear. So I talk about boundaries as the pause, and I tell a story in the book about when I first graduated from residency at GW, and this was 2016, and it was my first day on the faculty. And my mentor who is the head of our women’s mental health clinic, she took me out for lunch. And I was bright-eyed, bushy-tailed, first day on faculty. And she was like, “The one piece of advice for you, I have, Pooja, is you don’t have to answer your phone. You can let it go to voicemail, and then you can decide after you listen, you can decide how to respond.” And that for me was a big aha because I had just come from med school and residency where at that time we had pagers. And a pager would go off and you had this PTSD reaction, you had to call back. And I was like, “Oh.” And then for me in that context, it was like, okay, sometimes it’s the front desk and they have insurance paperwork, and I can call them back and say, I’ll do that. At the end of the day, sometimes it’s a patient who I know has ADHD, and if she misses a day of her stimulant, she literally might get into a car accident. So I’m going to put that refill in. But I decide. So the boundary is the pause, and then you get to say, yes, no, or negotiate, because the no always has a cost.

Emily Oster:

The other thing you’re talking about there is thinking deliberately about the idea of boundaries. That’s a tool, this idea of let it go to voicemail, that’s a tool. But also requires you to have started by saying, “Okay, where am I going to want to go? What are the boundaries? What are the structures I want to put in place that are going to get me there? And then how am I going to implement this plan that I have with this particular tool or this set of tools?” You got to think about it.

Pooja Lakshmin:

Yes. Right.

Emily Oster:

And be deliberate.

Pooja Lakshmin:

And you have to know, you do have to know yourself and know what you want and know what your future self will want. And so that takes time. So I think there’s also this element of you’re going to mess up. It’s not going to be perfect. That’s just part of the process. You’re collecting data too as you go along.

Emily Oster:

About what makes you happy, or what makes you fulfilled, or what makes your life the life that you want. This is something I talk about a lot in the context of structuring your family life, is actually sitting down and thinking about what do you want your day to look like? What do you want your weekends to look like? How do you want your family’s life to be structured? And it does then require sometimes sacrifices, no secret option C. You can’t both have family dinner every night and also have your kid do gymnastics from five to 8:00 PM every day. That’s just like, you can’t do both of those. And so sometimes you have to decide which of those things you’re going to do, and making that choice in a way that works for your family, that’s kind of is self-care. That’s what it is. That’s making a life that you’re going to be happy with most of the time, and not one that you will feel, I don’t know if you need to escape to your candles from.

Pooja Lakshmin:

Right or to the retreat or whatever it is.

Emily Oster:

Yoga retreat.

Pooja Lakshmin:

Right. Can I touch on another piece of that?

Emily Oster:

Yeah, totally.

Pooja Lakshmin:

Because I think that ties in, the next principle is compassion. And you have a great line in the family firm where you say… It’s where talking about the different parenting labels, like the helicopters, the chickens, the tiger, the ostrich. I love the ostrich.

Emily Oster:

Yes. My son read this, I want to say, and he was like, “Is that a real kind?” And I was like, “No, I made that up.” And he was like, “Oh, okay. It’s funny.” I was like, “All right, thanks.”

Pooja Lakshmin:

But you say parenting is in the end about what you do, not what you call it. And I think the same applies to self-care in that once you set the boundaries, the first thing that comes up, especially for moms, is guilt. And “Oh my God, I’m a selfish person.” But we need to let go of these labels and understand that the labels are just outside creation. That’s noise instead. And we can talk more about guilt, but it’s really about making the choices that align with the life that you want.

Emily Oster:

I think we should talk about the guilt because I think that one, maybe we’ve touched on this before, but for me, and I do want to come at the end to our kinds of personal self-care, but for me, one of my pieces of self-care is having a job outside of my home. That, for me, is a really important part of shaping the life that I want. And I think framing it in that way, that’s my self-care, this job, my office, this is how I am happy. I think for many people, this generates a lot of guilt. It can be hard to say, “I’m working outside my house and my kids have, they go to school, they have a nanny, they have whatever.” The thing that we want to say is, “I work outside the home. I have a job because I have to.” And saying, “I don’t have to, but I do because I like it.” Which I’ve said publicly many times. And sometimes people say, “That’s selfish. That’s not what’s the best thing for your kids.” And I think that can generate quite a lot of guilt.

Pooja Lakshmin:

Yeah. Well, and the presumption there, there’s two pieces. One is that you don’t matter. Your mental health doesn’t matter. Your wellbeing doesn’t matter. And that the only way that it could matter is if it leads to more well being for your kids.

Emily Oster:

Yes, exactly.

Pooja Lakshmin:

That’s the deflection people use.

Emily Oster:

Exactly.

Pooja Lakshmin:

“Well, I’m a better parent, because.” Which is true. For many people it’s true. But that doesn’t have to be the only reason.

Emily Oster:

Yeah. I think to be able to say, “Yes, I think that this probably does improve my parenting. I’m not sure my kids would benefit from having more of my time, frankly. Benefit from less. But I would work even if… That isn’t the only reason. And maybe it’s not even the primary reason. And even saying it like that to you, it feels a little bit like, “Oh, would I really say if I thought it was a little bit better for my kids, if I stayed home, would I still work?” I think the answer is yes. And maybe I am a terrible parent. Pooja, am I a terrible parent?

Pooja Lakshmin:

Well, no, you’re not a terrible parent. But this is just touching on… In the book, I talk about Martha Beck’s work. Martha Beck, the sociologist and Oprah Superstar. Her work has really been inspirational for me because she’s studied culture for her entire career. And she talks about how women have to reconcile the irreconcilable in our society. And exactly what you’re talking about, how moms are taught that their selflessness is their value, and also told at the same time that their self-care is something that they should be prioritizing and performing. So there was a study that I reference in the book from Mercer University, which surveyed moms, which they checked off both as a priority, but they’re in conflict. Our whole culture is set up that way. It’s not an accident. So this guilt that you feel, it’s from the outside. It’s not actually yours. So the way that I frame it with my patients is, and this comes from acceptance and commitment therapy, is think of this metaphor, think of the guilt as like a faulty check engine light on your car dash.

Emily Oster:

I love that. I’m totally going to use that as someone whose car frequently has this problem. Car and my emotions. Yeah, I love that. So can we talk about kids and the question of whether to have them at all? Because I think we are talking about this is mostly people who listen to this are parents, but some of them are not. And even if you are a parent, I got a question the other day, which maybe is a good way to frame here, where somebody said, “I only have one kid. I only want to have one kid.” And people told me that’s selfish. And their question was, “What should I say to them?” And my answer was like… I can’t repeat it because I’m trying to keep this podcast more PG. But basically how do we frame that out of… I think that’s a crazy thing to tell somebody.

Pooja Lakshmin:

Yeah. Yeah. I agree. I have a couple thoughts on this. So one is I’ve been through this internal conflict myself. And I wrote a piece for the Times, I think it was last year, about ambivalence around motherhood and my own ambivalence. I grew up an immigrant family. My family’s from South Asia, from India. And kind of the model of motherhood in that culture, in my culture is martyr. My mom stayed at home, everything was about sacrifice, and I was just growing up, I was like, “Oh, why would I want that?” And I went to Penn and I became a doctor, and it was like, “I’m going to throw myself into my career.” In my late twenties, I went through a divorce and kind of a whole life blowup/exploration, and I was kind of like, “I just don’t know if I want to do this.” So I only came to motherhood at 38 and a half. And it’s interesting because the piece that I wrote for the Times, of course I read the comments even though everybody says, don’t read the comments.

Emily Oster:

Don’t read the comments.

Pooja Lakshmin:

I know. Everybody says that, but does anybody actually take that advice?

Emily Oster:

My daughter once when she was during the throes of COVID, when people were saying really nasty things to me on the internet, I was explaining to my 10-year-old, I feel really bad because people are saying these things. And she was just like, “But do you have to read the comments?” And I was like, “Yeah, I don’t have to.” She’s like, “Maybe you shouldn’t.” I was like, “Okay, thanks.” Hello..

Pooja Lakshmin:

Yeah. Yeah. I just didn’t have the willpower, and the piece was all about prioritizing your mental health and that it’s okay as a mother. People were scathing around that. “Well, if you waited until you were 39 to have a baby, then clearly you never actually even wanted to be a mother. So why would you do it now?” So this is the stuff that people hear. I think the decision to become a parent is a real self-care decision. I would put it in, it’s like the 400 level class. It’s after you get through figuring out if it’s yoga or running or reading sci-fi, then that’s 101. And then you get to 400 and then it’s like, “Okay, do I want to be married? Do I want to have a kid?” And it’s normal. It’s normal to wrestle with that, because there’s no right answer. And there’s pros and cons. And of course there’s amazing things about being a parent.

Emily Oster:

And there’s also really hard things.

Pooja Lakshmin:

There’s also really hard things. And both are true. Both are true. I have a, I guess he’s a toddler now. He became a toddler in two weeks. It just suddenly overnight he switched from baby to toddler, and now he has all the toddler feelings and none of the words. And so it’s rough. And the highs are really high. He’s super cute and really fun and doing fun stuff. But again, it only works if it means something important to you. In Real Self-Care, I talk about eudemonic well being, which is based on this theory of well being means that your values, your internal values, and your life choices are aligned. It’s the opposite of hedonic well being. Hedonic well being means that wellbeing is the absence of suffering. So there will be suffering when you make choices that are aligned with your values, there will be. It’s kind of like what Mark Manson says, you just have to choose your suffering, which suffering is more tolerable for you because it means something.

Emily Oster:

And it’s interesting. So when we look at the data on marital satisfaction after kids, generally it goes down, but it goes down much less when people have planned. So the declines are much bigger if births are unplanned. And I think part of that is, by planning this, we have… Maybe we didn’t know exactly the frame of the suffering, but we’ve chosen something together that we know is going to have some of the complications and many of the joys that come with this. And that is a buffer against at least some of these kind of internal conflicts, not all of them, or external conflicts.

Pooja Lakshmin:

Right. And I think that the other question that you asked about whether to have more than one kid, this has been surprising for me because I always thought that deciding not to have kids was the most stigmatized decision. But now I’m in a place where people are asking me if I’m going to have another baby. And I’m really like, “I don’t know.” This has been really hard and it’s great, but I don’t know if we can handle another.

Emily Oster:

And then do people say, “But don’t you want to give him a sibling?”

Pooja Lakshmin:

Exactly. Somebody actually said to me that you can’t do that. That is so selfish. Literally. You have to give your child a sibling. You can’t just have one kid. I think she even said, “If you were going to do that, you shouldn’t have even had a kid.”

Emily Oster:

Oh my God.

Pooja Lakshmin:

I was… And I couldn’t even respond because I was so shocked. I just want to say, that’s not true. There are so many happy only children, and you can be perfectly happy deciding to have one child. But it’s people, I think when you make a choice that maybe goes against society’s expectations, it causes other people to then question their own decisions.

Emily Oster:

I think I totally agree with that. I would have said it slightly differently, which is when people make choices that are important to them, they want those choices to be right, and they want them to be so right that they’re right for everybody. And so saying, “I chose to have two kids, and it’s the choice that worked for me.” And that’s true. I have two kids. That was the number that we wanted when we had just one. I was like, “We’re not done.” As soon as the second one came out, I was like, “Okay, where’s the long-term birth control? Because we are totally a hundred percent done here.”

Pooja Lakshmin:

Right. Right.

Emily Oster:

Just so straight up rude.

Pooja Lakshmin:

Right. Well, and I think, of course, coming from a psychiatrist perspective, I always think about the messy internal conflict. And I think that what you’re describing from your position is somebody who is not conflicted. You made that choice based on what you knew you wanted and not based on what society wants. But when someone is making decisions based on more of an expectation, then you feel a little bit more threatened when you come across another person who has made a different choice.

Emily Oster:

I think for me, the most salient part for this is breastfeeding. For so many people, it’s very hard. And a lot of people, because of the expectations and the pressures we put, really push through very difficult circumstances and in ways that really, it hasn’t brought joy or certainly in the aggregate, maybe there’s more negatives than positives about that experience, but you think I’m doing it because it’s the most important thing. And then when someone says, “This wasn’t for me, I opted this other thing,” it’s very hard to say, “Well, I killed myself to do this, but I guess it wasn’t that big a deal.” And I think that’s where you sort of get into=.

Pooja Lakshmin:

Yeah. I agree.

Emily Oster:

… this really extreme judgment.

Pooja Lakshmin:

I think the breastfeeding piece is… That’s one of the hardest pieces in my practice with patients. And I start really early in pregnancy of putting those seeds out there that this is not the be all end all that there’s lots of options. But I use it as an example in Real Self-Care, actually, a patient who let go of breastfeeding, and that was a real self-care decision. And then once she made that choice, she was able to get back into working out in a way that felt nourishing for her. And she was able to go to the postpartum support group and actually take some of it in. But when she was stuck in that place of still breastfeeding, but feeling so resentful, none of the other methods worked.

Emily Oster:

Yeah. So tell me, what are you working on with your self-care? And then I’ll tell you mine.

Pooja Lakshmin:

Yes. So when I sold this book proposal, my therapist, I told my therapist, I was like, “How can I write a book about self-care? Because I’m a workaholic.” She was like, “Pooja, I think you’re going to learn a lot from this process.” I’ve always been really good at the… So I go to therapy. I have a coach that I work with. He helps me with some of these figuring out my career and things like that. But I’m great with boundaries. The issue for me is that I like to do a lot of things. So I notice that every couple years I go into another season of change. And right now I’m in another season of transition, where there’s just so much on my plate that I’m having to figure out… There’s no secret option C. I’m having to tell myself that.

Emily Oster:

Your body was like, “First we’re going to meet the gallstones.” So you were like, “Okay, okay. But I’m done with that.” And it was like, “You didn’t rest enough. I have other stones for you.”

Pooja Lakshmin:

Right. Exactly. So I am now… I recently joined the YMCA, and I’m walking, I’m not a runner. I know you’re a runner. I’m not a runner, but I’m walking and I’m taking time. I’m putting in three or four hours a week to just read for fun. I like to read sci-fi. And my son is in a really fun age. So for me, to be transparent, the early baby phase was not super fun. But now I’m noticing that I really like hanging out with him, and I want to have time to be with him. So I’m trying to figure out how to make that happen.

Emily Oster:

I find, I will tell you, I think as my kids have gotten older, I have only wanted to spend more time with them. And I have also increasingly felt like my time is less substitutable with other people’s. So when they were little, I usually thought our nanny was, if anything, quite a bit better because she’s very patient with the baby. But now there are things that they need me for and I really like them. They’re really interesting. Last night my son and I cooked together. It was so great. And then afterwards he was like, “This was so fun. I love cooking with you.” I was just like, “Oh my God, this is the greatest day of my whole life.” I’m not going to cry. It’s fine. So my self-care is running. And it’s interesting that… I have run for exercise for basically my whole life, but in the last couple of years, I started taking it, what my husband would describe, as too seriously. Fine.

Pooja Lakshmin:

Oh gosh. I love that last thing that you just said. Somehow this is enough for me. That’s so powerful. Because what I’m hearing is that it’s a practice for you because nobody else is dependent on it. You don’t get maybe the external accolades that come in other parts of your work sometimes. No one’s livelihood is dependent on it, but you still are doing it. The value, it’s completely internal.

Emily Oster:

It’s completely internal.

Pooja Lakshmin:

Yeah. Yeah. That’s such a great example. I think for me, writing used to be that, but now I have a book, so writing is also-

Emily Oster:

Your job.

Pooja Lakshmin:

Right. It became my job. So I’m trying to figure out how to get back to something that isn’t a job. So stay tuned for that.

Emily Oster:

Stay tuned. Stay tuned for your self-care. Okay. My producer, Tamar, is making hand gestures. I think she has a question for you, Pooja, and I want to let her ask it because I think I know what it’s going to be about.

Pooja Lakshmin:

I love that.

Tamar Avishai:

Okay. Well, so my question is, does self-care have to be something that is “good” for you? Because I’m realizing that my self-care is roller coasters. I’m actually going again tonight. We have a season pass. My husband and I have a season pass to Cedar Point. And there is something about doing something absolutely ridiculous that shoots the adrenaline. It shakes you out of your house and your day and you’re just screaming, going down a huge hill. And it’s like, I come back happy and restored. But I tell my family about it and they laugh at me. So is it… We think of self-care as something like, okay, well at least this makes you a healthier person, but do you get to choose what actually makes you healthy?

Pooja Lakshmin:

Okay, first, Tamar, I love this. I love this for you and your husband. I can hear it in your voice of, “I come back and I’m excited, I feel good. I’m energized.” You’re having fun. You’re playing. That is absolutely aligned with real self-care. And the other piece here is that it’s like no one thing is good or bad. It’s actually about the process that you take to get there. So the way that you’ve thought about it, the way that you’ve thought about what it brings to your life, the fact that you’re doing it together, maybe it started as something spontaneous and on a whim, but then you’ve thought more about it and realized that it had positive repercussions.

Tamar Avishai:

It’s a hard thing to ask for babysitting for. It’s a hard thing to think that that’s like a worthy…

Pooja Lakshmin:

But why is it any different than a date night?

Tamar Avishai:

I know.

Emily Oster:

Or going out to a restaurant? It’s actually healthier because you’re probably not drinking.

Tamar Avishai:

Although that also, it’s also hard to ask for a date night. It’s hard to ask for anything that just feels like-

Emily Oster:

Indulgent.

Tamar Avishai:

… decadent. Exactly.

Pooja Lakshmin:

Yeah.

Emily Oster:

I love your rollercoaster thing. It’s one of my favorites. Thanks, Tamar. So Pooja, your book is amazing. What is the one thing you wish people, maybe there’s a million things, but if you had to say one thing you wish people would take away from the book or from this conversation, what is it?

Pooja Lakshmin:

I think that it is, you can start now. You can start wherever you are. It can be one tiny thing. It can be an email that you sent to your boss about needing to leave at 4:30 instead of five. It can be saying to your partner, “Hey, can we have a talk tonight? I want to chat about something.” It doesn’t need to be big. And I think often, especially in the parenting context, it’s really common to feel like you’re drowning and you don’t want to think about one more thing. And I want to say that with real self-care, it doesn’t have to be anything big. And actually the small steps, the small little seeds they add up.

Emily Oster:

I love that so much. Thank you, Pooja. Thank you for being here.

Pooja Lakshmin:

Absolutely. It was such a pleasure to be here. Thanks for having me, Emily.