While I have often found myself to be somewhat skeptical about the concept of self-care, I recently listened to a podcast (3) on the topic that helped me crystalize my thinking on this topic. The psychiatrist and author, Dr. Pooja Lakshmin, was interviewed about the thesis of her book, Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included) (4). Dr. Lakshmin offers an incisive critique of the self-care movement. She refers to what she labels as “faux” self-care activities such as meditating, taking a bubble bath, or doing yoga. While not dismissing the value of these activities, Dr. Lakshmin focuses on how well meaning suggestions to engage in these activities can feel like another burden or task to be added to one’s to-do list, that may already feel overwhelming. Examples of these types of “faux” self-care activities are easily found with a quick google search (5). Dr. Lakshmin raises concerns that trying to find the time to engage in these self-care activities is problematic for many people. Of note, Dr. Lakshmin is a perinatal psychiatrist who works with women, and primarily new mothers. Dr. Lakshmin notes that women, and particularly new mothers and perhaps even more so working mothers, often feel overwhelmed with the many demands they are facing. Moreover, Dr. Lakshmin notes that if one does not find relief in these activities, this can only heighten feelings of stress and distress.
Self-care has often been touted as a solution to prevent burnout. Burnout has been defined, by the APA, as “physical, emotional or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others”(6). Psychologist Scott Miller has argued quite persuasively that the strategies often recommended to counteract or prevent burnout (7), which are remarkably similar to the strategies now cited as self-care strategies, are ineffective. These strategies include familiar self-care recommendations such as: meditation, finding time to take a walk, and “taking time out to value oneself.” Miller’s article on burnout was published in 2015, before the concept of self-care exploded into contemporary parlance. However, he points out that “an entire industry of authors, trainers and coaches has sprung up to address the problem [of burnout].” Again, a quick google search reveals a range of self-care “institutes” and self-care practitioners selling all types of services designed to promote self-care and prevent burnout (5). Miller argues that burnout often results from people (note: Miller is writing about and for therapists) feeling ineffective. Miller argues that the antidote for burnout is to focus on ways one can be more effective as a clinician rather than engaging in strategies to mitigate feelings of burnout. It is not difficult to extrapolate this argument to a broad range of other professions. Miller is highly critical of the strategies advanced to prevent burnout and argues that they do not address the core issues accounting for burnout which for Miller goes back to working conditions, demands placed on clinicians, and possibly most importantly having more control over one’s work and having a sense of efficacy/effectiveness. Workshops on self-care do not remedy the underlying conditions that lead to burnout. Miller then goes on to argue that feeling and being more effective as a clinician (again, substitute professional or even worker or parent) reduces feelings of burnout. In his work on highly successful therapists (8) Miller notes that these clinicians appear to experience less burnout and typically did not utilize what we would now label as self-care strategies. Rather, they had lower rates of client drop out and higher rates of client improvement.
Lakshmin’s work both overlaps and differs from Millers. First, she is not focused on mental health professionals but is providing a more general discussion of self-care. Second, both authors are highly critical of the typical self-care/burnout prevention strategies as the solution to the problems of burnout, stress and distress. While neither is denigrating these strategies for those who find them helpful, both are arguing that they are not the real solution to the problems at hand and in fact can inadvertently cause professionals, clients, and the general public more distress as we feel obligated to add these strategies to our lives, do them consistently, and benefit from them. Third, both touch on the issue of self-blame that can arise from failing to benefit from these strategies. Lakshmin is much more explicit in addressing this issue. Her discussion of this effect reminded me of Barbara Ehrenreich’s critiques of the Positive Psychology movement (9), which (apologies for the over simplification) advocates the power of positive thinking as the solution to many of our problems, and of a classic work, Blaming the Victim, by William Ryan (10), which argues that American society tends to blame those who are not successful for their failures and struggles, and neglects to consider the social determinants of people’s struggles. Ryan’s work is prescient, and sadly frequently not noted by contemporary authors, who focus on the negative impact of social structures, social inequities and cultural maladies. Fourth, both Lakshmin and Miller focus on what they believe are more effective ways to address burnout, feelings of stress, and feelings of being overwhelmed by work/life’s demands. It is difficult to compare their strategies or prescriptions because of their different foci. However, both emphasize that the current strategies and practices recommended by the burnout and self-care industries are not the solution.
Lakshmin emphasizes the importance of kindness to self (decreasing self-criticism for not being able to “do it all” and for not being able to adhere to all the principles of good self-care), clarifying one’s values so that one makes healthier choices, and setting clear boundaries and saying no to demands (when possible) that are excessive. Her fourth principle is more amorphous, focuses more on establishing a broader sense of community and connection with others. Unfortunately, while these recommendations are clearly sensible they also have the pitfall that is associated with many self-care strategies, that one can feel worse if one is not successful. Most experienced therapists will acknowledge trying to help clients be less self-critical only to learn that clients who have struggled with this will be critical of themselves for failing to lessen their self-criticalness. Similarly, the same problem can occur with taking the time to clarify values and set better boundaries. Clearly, in her work and recommendations Lakshmin is mindful of these pitfalls. In the podcast she talks quite eloquently about how if one cannot say no/set a boundary that they believe is appropriate, they can acknowledge this and think about what steps they can take in their life to reach the point where setting this boundary may be possible. Similarly, Miller’s focus on improving therapeutic efficacy as a solution to burnout faces the same challenge: the implementation of his recommendations is not easy.
It is important to note that a number of other voices have raised similar concerns about the self-care industry and the seemingly endless focus on self-care. These critics make many of the same arguments at Lakshmin and Miller. In conclusion, Lakshmin, Miller, and others such as Barbara Ehrenreich and Rina Raphael (11) offer important critiques of anti-burnout and self-care strategies. None of these authors denigrate efforts to take better care of one’s self: exercise, get more sleep, and the like. However, they are all dismissive of specific self-care activities that Lakshmin would label as “faux” self-care. Perhaps most importantly they direct us away from false promises to solve our feelings of burnout and stress, and point us to the broader social conditions that likely contribute to these feelings.
- From the website the “Very Well Mind, https://www.verywellmind.com/self-care-strategies-overall-stress-reduction-3144729
- From the website Talkspace (which is also an online therapy provider). https://www.talkspace.com/blog/self-care-for-therapists/
- Erza Klient show, Podcast, “Boundaries, Burnout and the goopification of self-care”, https://www.nytimes.com/2023/09/19/opinion/ezra-klein-podcast-pooja-lakshmin.html
- Lakshmin, P. Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included),
- Examples of more blatantly commercial self-care can easily be found. One example that popped up in my google search that illustrates this trend is: Radical Self-Care, https://www.thehappygoddess.com/product/radical-self-care-workshop/. However, there are a myriad of other sites selling self-care programs, workshops, and products. Another good example of this is the site: Golden Apple Health Arts, at: https://www.goldenapplehealingarts.com/
- American Psychological Association’s dictionary of psychological terms. https://dictionary.apa.org/
- Miller, S., Burnout: New approaches to rekindling the flame. Psychotherapy Networker, May-June, 2015. https://www.scottdmiller.com/wp-content/uploads/2012/11/Burnout-Reconsidered.pdf
- Miller, S., Hubble, M., and Duncan, B. Supershrinks: Pathways to excellence. Psychotherapy Network, November-December, 2007.
- Ehrenreich, B. Bright Sided: how the relentless promotion of positive thinking has undermined America. Metropolitan Books, 2009.
- Ryan, William. Blaming the Victim. Random House, 1971.
- Additional critiques of the self-care industry include:
- Rina Raphael in our book: The Gospel of Wellness: Gyms, Gurus, Goop, and the False Promise of Self-Care. https://www.amazon.com/Gospel-Wellness-Gurus-Promise-Self-Care-ebook/dp/B09NHJVM59
- Barbara Ehrenreich’s recent book: Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing ourselves to Live Longer Hardcover, 2018
- See a very recent article in the Guardian, November 1, 2023 by Katherine Rowland: ‘We’re sedating women with self-care’: how we became obsessed with wellness” for a summary of more critiques of the wellness and self-care obsession, and its particularly negative impact on women.