BY POOJA LAKSHMIN, MD

In the past few years, I’ve noticed something curious happening.

For women, the cultural obsession with self-care has been an attempt to bring solace to a busy life—perhaps by taking a weekly yoga class or going on a boutique retreat in the mountains.

But instead of bringing long-term relief, these women are feeling more guilt and pressure than before, ultimately feeling a sense of failure.

A common refrain I hear in my psychiatric practice is “I’m burned out, I just can’t do it anymore, AND I feel like it’s my fault because I should be taking care of myself.”

Self-care ends up being another burden, another thing on the to-do list for women to feel bad about because they aren’t doing it right. I call this the tyranny of self-care.

Commodified wellness is not working for American women, as data has proven. Women not only report higher stress levels than men but also feel they are not doing a good job of managing it.

A 2018 Canadian study of more than two thousand workers found that women reported higher levels of burnout compared to men.

Yet, curiously, search Instagram and you’ll find more than sixty million posts tagged with #SelfCare. They run the gamut from beachside yoga to triumphant mommy blogs to “curative” smoothie recipes. If we use social media as our guide, self-care appears to be… anything that looks good in a photo?

The Tyranny of Self-Care

Wellness behaviors and practices are sold as a remedy for women’s problems. In many cases, faux self-care is just a sugar high, serving as an escape from our true selves. Faux self-care is also big business.

A report from the Global Wellness Institute found that the global wellness industry, which is particularly targeted at women, was worth $4.5 trillion in 2017. While products like crystal-infused water bottles or vagus nerve pillow sprays might elicit a temporary sense of calm, they do nothing to change the social systems that have us craving relief in the first place. This allows the cycle of consumerism and underlying fatigue to continue unwavering.

Even departing to the “easier” and “cost-effective” options comes with its own struggles. One of my patients, a thirty-eight-year-old mom of three, came to me asking why the self-care she was following didn’t work for her.

As she explored at-home meditation and gratitude lists, she found she was feeling worse. “If everyone else seems to feel better with a bubble bath and a glass of wine, what’s wrong with me that I can’t get it together to make that happen?”

Stories like this have become common within my clinical practice. Regardless of their background or age, they all share the commonality of struggling and relying on self-care methods.

That’s the problem—faux self-care is a method. In the moment, going for a run might improve your mood, but it does nothing to change the circumstances in your life that led you to feel drained, energy-less, or down.

How We Turn to Faux Self-Care

I’ll lead you through the three most common reasons why we turn to faux self-care—escape, achievement, and optimization. It’s important to remember that these coping mechanisms are not bad—we turn to them for relief during times of stress and overwhelm. The issue is they often aren’t meeting our deeper needs, and thus end up being Band-Aids instead of sustainable solutions.

Escapism—Whether we know it or not, we turn to this type of faux self-care out of the desire to escape ourselves. Maybe we are running away from grief or destruction due to a failed marriage or the death of a family member. It’s understandable—in dark times, we are looking for a place of refuge.

Or maybe for you, it’s not a loss that you are running from, but the drudgery of daily life, and every small decision could lead to emotional baggage.

“Should I make cupcakes for my kid’s school, or should I pick some up from the store? If I pick them up from the store, does that mean I’m a bad mom?” This is an internal conflict, and the faux self-care masks it. Temporarily.

However, the truth is that the frills of our daily lives, the interpersonal struggles, and dealing with the internal conflicts—all of this make us who we are. It’s in the decisions we make in the real world that we mold ourselves and discover what truly matters.

I understand that working through life’s hardships and taking the time to heal from them is difficult work. However, I assure you that the quick solution never provides a sustainable relief.

Achievement—Many of us grow up with a feeling that we are not good enough just the way we are. But for some women, this deficit can feel so impactful that the need to succeed can become blinding.

A 2016 survey of 2,000 women conducted by Weight Watchers found that women criticized themselves on average eight times a day, with almost half reporting that self-critical thoughts started before 9:30 AM. Sixty percent of women in this survey said they had days in which they criticized themselves nonstop. For women fueled by this kind of self-criticism, life can feel like a series of races, each of which must be won to prove our worth.

The drive to succeed commonly manifests in a relentless pursuit of faux self-care achievements. None of which actually nourishes our true selves. To the contrary, engaging in faux self-care as a coping mechanism only sets us down a path of endless competition, leaving us tired, burned out, and less engaged with what really matters in life.

Optimization—Focusing on efficiency and productivity is a trip that keeps women spinning on a hamster wheel, especially women operating under the weight of running a household. It’s a fallacy that having an infant sleep gadget or a secret to scheduling will transform our lives.

This type of faux self-care, optimization, is seductive because it whispers to us, “Here’s the magic solution.” It promises us that someday we can reach a pinnacle of productivity and efficiency, but the problem is that we never actually arrive there.

It’s the Silicon Valley ethos, the “Lean In” culture, adopted by Sheryl Sandberg, that says, “Just keep doing more, more, and more, and eventually, you’ll get ‘there.’” The problem is that when women buy into the faux self-care complex, they usually don’t think deeply about where “there” is.

When you use efficiency as a coping mechanism to deal with the chaos of modern life, it’s very easy to forget the real point of efficiency—to free up time and space for yourself.

The faux self-care of optimization can make you fall into the trap of becoming something or someone else. Someone more productive. Someone more shiny. But what if real fulfillment—and real self-care—is about becoming yourself.

Taking Back the Reins

If real self-care isn’t a life hack, a wellness retreat, or the latest fad, then what is it?

Real self-care is not a noun, it’s a verb—an ongoing internal process that guides us toward profound emotional wellness and reimagines how we interact with others. It requires self-knowledge, self-compassion, and ultimately, the willingness to make difficult decisions.

What I’ve come to learn through working with my patients, reading the scientific research on well being, and reflecting on my personal therapeutic journey is that the twenty-first-century definition of real self-care corresponds more closely to a concept called eudaimonic well being.

In many respects, faux self-care is aligned with a hedonic approach, which focuses on what feels good in the moment, such as diets, cleanses, or retreats. These all feel good in the moment, but they ultimately lead to escaping life’s real situations.

Eudaimonic well being, in contrast, focuses on deriving meaning and having our actions align with our values. Instead of prioritizing pleasure or happiness, eudaimonic well being emphasizes personal growth, acceptance of your authentic self, and connection to purpose and meaning.

The work of real self-care is going deeper and identifying the core principles to guide decision-making. When you apply these principles to your life, you don’t just feel relief in the moment, you design a system of living that prevents problems from coming up in the first place. In other words, applying a methodology of faux self-care is reactive, whereas practicing real self-care is proactive.

Not surprisingly, real self-care is linked to better health outcomes. Including improved sleep, a longer lifespan, and lower inflammation, as we age. Showing the benefits of real selfcare in the long run. All the good stuff we’re looking for, right?

The million-dollar question, of course, is how to distinguish real selfcare from the coping mechanisms of faux self-care. How do we ensure that we are practicing the kind of real selfcare that is likely to lead to profound fulfillment?

The answer is to take the time to align our self-care practices with the following four principles, all of which are based on moving toward eudaimonic well being.

Setting Boundaries and Moving Past Guilt

At its core, real self-care is ultimately about decision-making. When making decisions that foster eudaimonic well being, you must be assertive in prioritizing your own needs and desires.

To do that, you must learn to say no and set boundaries. This often means balancing the needs of people close to you with your own desires, needs, or feelings.

Learning how to stop being controlled by feelings of guilt—which are inevitable—but can be managed.

Treating Yourself with Compassion

Once you’ve gotten a grasp on how to set boundaries, the next step of real self-care is to insert compassion into how you speak to yourself.

Practicing real self-care means looking honestly and unflinchingly at what you need (and what you want) and giving yourself permission to have it.

This is only possible if you cultivate compassion for yourself.

Being Closer to Yourself

While faux self-care takes you further from yourself, real self-care always brings you closer to the most authentic version of yourself.

It’s a process of getting to know yourself—your real self—including your core values, beliefs, and desires. It’s an internal decision-making process that requires introspection, honesty, and perseverance.

You’ll know you’re practicing real self-care when it feels like your outsides are matching your insides.

Assertion of Power

Faux self-care only serves to keep women small. Real self-care is about making yourself bigger, and in turn, shifting long-standing systems of power.

While we have long been taught to wait for permission to exert this type of control over our lives, we are the only ones who can give ourselves permission to practice real self-care.

Make no mistake—real self-care, wherein you look inside yourself and make a decision from a place of reflection and consideration, is an assertion of power. It’s about saying this is what works for me, and this is what doesn’t.

It’s having the audacity to say, “I exist, and I matter.”

The Long Haul

As a psychiatrist, I have the clinical training and the expertise, but, as many others can relate, I struggle with taking my own advice. However, I’m not here to give you advice from the top of the mountain. I’m here as a fellow traveler alongside you.

It can be disheartening to learn that real self-care is not a neat and tidy solution, but that is okay. Remember, faux self-care prescribes methods whereas real self-care focuses on principles.

This is critical because living by your principles is a lifelong process. Your circumstances will constantly change, with endless possibilities. You will constantly need to learn how to apply the principles of real self-care to new situations, but you will become more practiced and confident in applying these principles over time.

A tidy solution could never work for the long haul, and folks, we are in it together for the long haul.

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Pooja Lakshmin, MD, is a board-certified psychiatrist, New York Times contributor, and a leading voice at the intersection of mental health and gender, focused on helping women and people from marginalized communities escape the tyranny of self-care. In 2020, Lakshmin founded Gemma—a physician-led women’s mental health education platform centering impact and equity.

She maintains an active private practice, where she treats women struggling with burnout, perfectionism, and disillusionment, as well as clinical conditions like depression and anxiety. Having gone down the rabbit hole of extreme wellness herself, Real Self-Care is Lakshmin’s answer to the juice cleanses, the gratitude lists, and the bubble baths —not only to care for ourselves for real but, in turn, to transform our broken culture.

Well Being Journal adapted the above excerpt from Real Self-Care by Pooja Lakshmin, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2023 by Pooja Lakshmin.