Fresh Take: Dr. Pooja Lakshmin on Burnout and Mom Guilt

Fresh Take: Dr. Pooja Lakshmin

Margaret: Hello, everyone. And welcome to fresh take from what fresh hell. Laughing in the face of motherhood. This is Margaret and this 

Amy: is Amy. And today we're talking to Dr. Pooja Lakshmin. She’s a psychiatrist and author specializing in women's mental health. She's a frequent contributor to the New York times and the founder of Gemma.

Digital education platform dedicated exclusively to women's mental health. Dr. Lakshman is passionate about empowering women and sees her clinical work as a perinatal psychiatrist. As an extension of this mission, we're going to be talking about mom guilt today. Stress, self care, the anxiety of this pandemic moment and how we can reclaim ourselves amidst it all.

Welcome. 

Dr. Pooja Lakshmin: I'm so excited to be here. Thank you for having me. 

Amy: So your practice treats women who are suffering from burnout, disconnection, disillusionment. 100% of women right now. 

Margaret: I mean, it's 100% of the hosts of the podcast. 

Dr. Pooja Lakshmin: Yeah. I mean, it's pretty close to 100% of women in general too, I would say. But certainly, you know, there was no shortage of these conditions, even pre pandemic.

For sure. But over the past year and a half, things have reached sort of a fever pitch and the solutions have gotten much less clear as well over the past year and a half, because there's just no give from any side. So it's definitely. 

Margaret: Let's start at a really granular level. So I feel like mom burnout is something that we hear that term.

What does that refer to? How does that manifest itself? Yeah, 

Dr. Pooja Lakshmin: this is a really interesting topic for me. the thing with burnout, you know, burnout has kind of a triad of symptoms. It's this disconnection from meaning. So, you know, you're going through all the motions, but it all feels pointless. There's this lack of ability to kind of regulate your own emotions and to really feel like you have control over what's going on in your mind and in your brain.

But the thing with burnout is that it puts the onus of responsibility. Back on the person, who's feeling the burnout. And that's my problem with burnout as kind of a box to put people in. Cause then it's just like, well, why are you burnt out? You should learn how to meditate. You should be going to yoga.

You should be doing self care. And of course, none of my patients have time for any of that stuff. And so in that article, I talked about how, no, this isn't burnout, this is the trail. This is, you know, these are structures that are much larger than us. These are people in power. Who made the decisions that they have that then put families, moms mostly in these awful positions where you have to make choices.

That don't feel good. And that's why I think kind of that frame of turning it back on our systems is so important 

Margaret: and understanding that that might not be a breathing exercise away from food. 

Dr. Pooja Lakshmin: Right. And I think it's really condescending to say to people like, well, just do some mindfulness as if that's easy to do.

Right. 

Amy: But you make a point, we've talked on the show before about sort of the meta emotional states you can get in. I think particularly as moms that you have this. Your burnout, your disillusionment, whatever it is. And then the guilt about that gets layered on the feeling about the feeling. And it removes us even further from doing something about 

Dr. Pooja Lakshmin: it.

Totally. And I would say kind of in the past five years or so, I've seen that so much more in my clinical practice, that guilt and shame. Because of the burnout. I think that's a relatively new phenomenon over the past couple of years where women are coming in and they're saying, you know, I have no time for myself.

I'm exhausted. I'm burnt out. I'm depressed, I'm stressed all the time. I'm anxious. And then I feel like it's my fault. Because I haven't taken the time. I don't have the time to figure out how to take care of myself. And that added layer is I think new and that's, what's so painful, I think for women and like so much of my work.

Clinically and writing and in the social media space is like helping women to remember, this is not your fault. We're all feeling this and the reason, and we're all feeling this, this 

Margaret: is not your fault. I was talking to a friend yesterday about, she lost her husband at a very young age and was raising four children by herself.

And she was saying, you know, I just feel so bad. I just feel like my kids are gonna remember me always yelling and being anxious. And I said, Yeah. I've been having a difficult time with a situation myself. And I said, it's just, I just feel like I'm yelling all the time. And it's like, we put ourselves and our flaws at the center of the definition.

And I was saying, you know, I think that your girls are going to look back and be like, I can't believe my mom went through this thing and survived, you know, and that the yelling was a symptom of a real problem, but we kind of skipped the problem and we go right to like, if only I could get more self care.

These problems, you know, we skipped the problem. Right? 

Dr. Pooja Lakshmin: Well, and I think part of that is because the problems don't have easy solutions and the problems in our culture are like the answers to those problems are so contradictory. There's not an easy solution based on who you follow on social media or what self-help book you read, or, you know, what your friends say.

There's a million different answers and each sort of quote, unquote, recipe that you choose to try and fix your problems. There's going to be another peanut gallery that says no, no, no, you're not doing it right. You know, you should be doing the other thing. You should be making the other choice. There's no way to please our culture.

As a woman, as a mom in particular, it occurs to me 

Amy: as you're saying this. I mean, I remember that new mom feeling very much and you, a lot of your patients are new moms dealing with that very intense moment. You're doing it wrong. And you're really not sure what you're doing. And it occurs to me as you're speaking that this pandemic has brought that to all of us.

You're doing it wrong. If you're sending your kid to school and there's not a mask mandate, you're doing it wrong. If you're keeping them home, you're doing it wrong. Did every decision you make? There's no certainty. You said something the New York times I want to quote, cause it blew my mind because I'm like, yep.

This is where I'm at. In times of chaos, you wrote the dog had search for certainty can itself lead to distress. It's seductive to believe that if you worry about something for long enough, you can affect the outcome. But this is a fallacy I thought, oh, 

Margaret: I really needed to read that today. 

Amy: The search for certainty is part of the problem.

Dr. Pooja Lakshmin: Yes. And to be fair, that existed in motherhood and parenthood pre pandemic. But I think you're absolutely right that the pandemic and just the utter systemic failures and guidance from the folks who did have the power to sort of make choices that could help everybody, that failure then puts the onus on individuals and families to make all these decisions.

And it's moms, usually that they're the ones that are weighing all the data and trying to figure it out. There are no right 

Margaret: answers. Right. And I think that we are conditioned to some degree to feel like there's a bad mom door and a good mom door. And that you're either going through the bad mom door or the good mom door.

And that, you know, if you have a crisis and your spouse passes away, like you're kind of doomed to the bad mom door and. In this conversation yesterday, but I don't quite know what the other solution to that is. Like, how do we kind of get out of this feeling of there's constantly a scale and it's either tilting towards I'm a terrible parent or I'm a good parent.

And when I look online, I'm like, oh no, I guess I'm a parent terrible parent because everyone else seems to be a good parent. Like how do we stay out of that trap? Yeah, 

Dr. Pooja Lakshmin: that's a really, really good question. And I guess I, a couple of pillars to that or pieces to that one is recognizing how much external stimulation you're taking in, like who are the people that you're following?

What are the podcasts that you're listening to? You know, what is the information that you're taking in? Are you taking in conversations like this, right? Where people are actually questioning. Sort of the values and questioning the conversation or are you just sort of blindly consuming the influencers and 

Margaret: whoever like the perfect picture?

The kind of like, oh, everyone's making me feel bad. Cause it looks like they're making their Halloween costumes in August and getting ready for the holidays in June or whatever. Yeah. Right, right. 

Dr. Pooja Lakshmin: Which we know, we all know that's not true. We all know that that is just a highlight reel. But when you're surrounded by that constantly, it's so hard for your brain to remember to do that cognitive work of reminding yourself.

This is not real. This mindful answer is just showing me a tiny snapshot of what she wants me to see what she wants to sell me. So that's part of it. The other thing I would say is like, what I see in my practice and in my work is like the hardest thing for me. Is to ask for help and to accept help, and to really internalize the fact that we can not, nobody can do it alone and it's okay to.

Say I can't do this. And I need help, whether that is making an appointment with a therapist, whether that is texting your friend and saying, Hey, can you organize a meal train for us this week? Because it's just not happening. Things are a mess or whether it's like going to your neighbor and asking if they can watch your kids for an hour, you know, just that's so hard.

And I think that gets back to this cultural notion. Yeah. As women we're supposed to be super humans. We're supposed to have it all figured out. Everything's supposed to be perfect. We're supposed to know that. Yeah. 

Margaret: And if we accept, help, it nudges us somehow towards the bad mom door, I was out the other day, just at school pickup.

And I've been having a tough month for different reasons. And somebody said, oh, we'd love to bring you a meal. Her husband's a chef. Like, it's not that hard for him to make a meal. It's not a huge. Know, and I was like, no, no, no, it's fine. And three of my mom, friends who were standing with me said, you do need a meal, say yes.

Say yes. And it really struck me, like, what is this instinct? I have to be like, I mean, it would really help me if someone made me a meal, but I'm standing there going, no, no, no. Oh God, I couldn't trouble you. Right. Because of course I have it all together. Right. I still have four 

Amy: limbs, 

Margaret: so. Right, right. Yeah.

I'm not actually on fire. So why would I need you to make me a meal? 

Dr. Pooja Lakshmin: Right. Cause it feels like a failure on your part. Yeah. And the interesting thing is from the other side for your friend, if you could say yes, she would feel good. She needs to help you. Right. It feels so much better from the other side, too, to be able to give and help, you know, 

Amy: so much sense.

Okay. We're going to take a break, come back with more with Dr. Pooja. Okay. We're back with Dr. Pooja. Lakshman I wanted to ask about perfectionism and where that fits into this, because it seems like that is that what's keeping us from saying yes to the chef husband making us a meal. 

Margaret: That's a pretty good deal.

We're not asking for a friend as it turns out. 

Dr. Pooja Lakshmin: Yeah, I think so. Perfectionism is something that I definitely see in my practice all the time. And I think that it fits in this picture of sort of like control. And wanting to portray a certain image and this really harsh inner critic that for moms in particular, I think is really telling everybody, like, you need to do it yourself.

That needs to look a certain way. It only counts as a win if you've done it in this certain way. Right. And I think that, especially for new parents, perfectionism is such a. Compelling measuring stick to use when you're in the chaos of trying to figure out how do I take care of. Infant, if you're a first time parent and you're kind of like, To having some type of like a manual and recipe book. And you want to note the thing that makes you feel better about yourself is knowing that you're doing it right. Of course, you're going to want to put that internal ruler and measuring stick on this new role, this huge new role of being a mom and what better way then to use perfectionism, because for so many of my patients, perfectionism got you really far in life, you know, got you through college.

Either undergrad, maybe got you through grad school or the workplace and it worked. You know, but you didn't really see the cost until you became a parent. That makes a lot of sense to me or the costs were not too bad, you know, you could kind of push 

Margaret: through it workable. Right? Right. I also think another thing that the pandemic has introduced, and this is the same with new parents is, well, I don't have it that bad.

You know, we have friends who've lost their homes. We just had a huge flood where I live there's people with. Earthly possessions out on the lawn. Like, and then I feel like, well, I'm kind of having a bit of a hard time, but I mean, it's not like, you know, I'm sick. It's not like this. It's not like that. It often feels like in this very chaotic time that we're in the middle of that somehow we don't deserve help or we don't deserve to make room for our own struggles because other people are really in desperate straits, 100%.

What do you do with that? You know, is that just something we have to let go of for ourselves? 

Dr. Pooja Lakshmin: Yeah, I think that that's a really good point and that's something that I see. With my patients all the 

Margaret: time and I'm feeling it, I'm like, I know I'm struggling, but come on. I'm not really struggling. Like these people are struggling, 

Dr. Pooja Lakshmin: right?

Not enough to get the meal from the chef. 

Margaret: I don't enough to get the meal from the chef who happens to be my nurse. 

Amy: It's the feeling and then the feeling about the feeling, right? It's like, oh, I'm overwhelmed, but I shouldn't feel overwhelmed. I should feel grateful. At least I don't have my belongings out in the lawn.

And it's the feeling about the feeling that's keeping you from taking action? Yeah. And 

Dr. Pooja Lakshmin: I think the answer one of the answers, right? Cause there's never one right answer, but one reframe of it is to actually go back to that binary that you put out earlier. Am I a good parent or a bad parent, instead of saying, am I winning or losing?

Am I suffering or am I okay instead opening it up to give yourself the space to say, just sort of think about the perspective. Yes. There's all these ways in which we're fortunate and we're not out on the street and we have a home, et cetera. And I also feel kind of bad right now and there's crap going on and it's hard and both can be true.

Margaret: Right. And my hard can be hard. Even if someone else's hard might be harder. Like, yeah. I'm hearing that today. I'm hearing that, like, it doesn't have to be a competition. Yeah. It's not a competition. Nobody's 

Amy: looking at that person, right. Nobody's saying like, huh? I can't believe she took a meal when there's 

Margaret: a flood two towns over.

Right. The only person who's doing that, Amy is me to myself. So there is one person doing it. It's me. I'm lying in bed. Like I can't believe she did it. I hope she doesn't enjoy that steak from the chef. 

Dr. Pooja Lakshmin: And I think part of that too, is sort of like, there's a fear that if you do it once, are you going to just sort of melts into this pedal of gluttony?

Like, is it just, you know, if you have this one night of relief, Is that, what does that mean? Does that mean that you're not going to be able to pull it back together the rest of the week? And so it's sort of like, we really have to build this muscle of accepting help. It's like you have to learn the practice of what does it mean to incorporate bits of help into your yeah.

And trust that you can handle it. Yeah. 

Margaret: All right. I'm taking the steak people. This is, I've made the decision I'm texting right after we get off this and are going to bring me that steak. 

Amy: So something else is completely problematic for most women is self. Right is making the time, as you said, like the least useful thing in the world to say to an overwhelmed new mother is that they should make more time for themselves, right?

Like, yeah. Right. I should fly to the moon. How do you frame self-care for the women you work with in a way that's useful, instead of another thing to feel bad that they're not. 

Dr. Pooja Lakshmin: Yeah. So this is something that I've been, you know, thinking about probably for like the past decade after, you know, going through training to become a physician and being burned out in medical school and residency, and sort of constantly being told.

Yeah. Like do some yoga, learn how to meditate, you know, which, you know, I've done it at different points and gotten really deep into at different points, but it always. I always fall off the wagon essentially. And the only thing that really worked for me was learning how to set them. And how to say no and how to make clear choices in my life and be okay with those choices.

And so a couple years ago, maybe two or three years ago, when I started noticing that I was seeing more and more of this in my practice in terms of women who are coming up, coming in, burnt out and disillusioned and depressed. Felt ashamed because they weren't doing self care. I started thinking kind of more deeply about, well then what is real self care?

If all of this stuff that we're being sort of sold off the shelf, you know, the apps and the diets and the juice cleanses and the yoga retreats and all these different things. If they're not doing it because nobody has time. And even when you do do those things, There are sort of only a temporary fix 

Margaret: you're right back to real life.

I got a massage two weeks ago and by the time I got home, I was like, all right, that's undone out with my car door. And someone's standing there being like, there's no milk. And he hit me. I'm like, okay, that was a waste of a hundred. 

Dr. Pooja Lakshmin: Right. And the other thing is too. I love getting massages. I love goat.

Right? It's like, those are great, but you need to know what it is. Like, you need to know why you're doing it. Yeah. Right. 

Margaret: It has a role, but it's not the role we try to give it. 

Dr. Pooja Lakshmin: So right now I'm actually, I'm writing this book and I'm thinking about it a lot. And, and the kind of the frame for the book is that.

Real self care is not a noun. It's a verb. Real self care is all of the internal work that you do to get yourself to the massage or get yourself to the yoga class. Because one person's yoga class can be completely performative. They could be taking selfies and posting on Instagram and just doing it for them.

The dopamine hit and another person's yoga class actually can be deeply nourishing. So it's less about the thing that you do. And it's more about all of the internal work that you do to, you know, give yourself compassion, to set boundaries, to have hard conversations, to deal with the guilt that gets you to whatever that activity is.

And, and it can't be something that is sort of like prescribed by. An outside source. It really has to come from you. And 

Margaret: it strikes me listening to you that this has really, I don't think ever occurred to me before we talk a lot about like the playroom and people are always like, how do you organize the playroom?

And we've said many times the playroom starts at your front door, not at the bins in the playroom. Right? Stop so much stuff from coming in. That's the solution organizer, your playroom, not getting 20 more bins. And it seems like a metaphor for what you're saying. And it's a way of thinking about self-care that haven't thought of it before.

Like the self care isn't really getting the massage. It's stopping maybe the fourth trip to see family that's too overwhelming for you or taking on, you know, the role of class mom. If you can't handle it this semester, like. In the same way, you have to kind of stop some stuff at the door because you're not going to solve it all with massages and yoga later on 

Dr. Pooja Lakshmin: 100%.

And it's really about like, getting clear on your values and your priorities. And that's hard because that means like you can't do everything. 

Amy: How do you advise the women in your practice? Because many of them it's perinatal. So many women have teeny tiny babies at home. Right. So they're not at the place yet where they.

Make time for that yoga class, they love three days a week. They've got to start a lot smaller because they're so tied to their infant. How do you help them discern what self-care 

Dr. Pooja Lakshmin: means? Yeah. So in that early stage, we are talking about sleep. We're talking about sleep and we're talking about feeding your baby and the decisions that you're making around sleep and feeding your baby.

So a place where I see this kind of show. So much is around it. I know that this is a polarizing topic around breastfeeding and the choices that you make with breastfeeding. And I think it's so easy for women to kind of martyr themselves in service. Exclusive breastfeeding or, you know, it was just whatever expectation that you had in your head of what it's going to look like and underestimate the 

Amy: costs.

Yeah. One bottle a week will ruin your supply, right. Will ruin everything forever. And so you can't ever sleep four hours in a row that it's not worth the cost of that you're saying, 

Dr. Pooja Lakshmin: right. Because you know, from obviously from my frame as a psychiatry, I'm really looking out for mom's mental health and mom's wellbeing, which is the most important thing actually for baby's wellbeing.

So, you know, just a story that I like to share is like a patient of mine who was, had a preemie. And so they were doing, you know, Triple feeds where she was nursing and then she was pumping and then they did have to get formula because the baby was trying to be, they're trying to gain weight, et cetera.

And this was going on for weeks and weeks. And she was, you know, getting like an hour of sleep here. There may be like, it was a mess. And she finally, she had this moment where, you know, she passed her daughter off to her husband who got to do the burping and the cuddling. And she saw the two of them. In that like, just really loving moment.

And she felt incredibly jealous cause she didn't get to have it with her daughter because her daughter was totally fighting breastfeeding. And that moment for us was like, we just kind of like dug into that and we're like, that's not who I want to be as a mom. I don't want to feel resentful of my daughter.

I don't want to be jealous of my husband and that enabled. To then help her make choices around letting go of nursing. And I'm not saying that's the choice that everyone has to make, but it's just sort of like loosening up that framework. 

Margaret: For yourself. And it's also a metaphor that extends into teen DM.

And beyond that, you know, Amy and I have both felt that feeling of like, oh, here it comes. Good time, Charlie. My husband have a good time with the kids while I go back to filling out the forms. And rather than sitting in that head space. It's a great idea to try to ask yourself, like, how can I change this role so that I get more of the good times and less of the form filling out rather than just kind of stay in the place of like I do all the work and other people have all the fun with my kids.

All right. Let's take a break. And when we come back, we will talk a little bit about Gemma. Okay. 

Amy: We're back talking to Dr. Pooja Lakshman who did tell us about Gemma? 

Dr. Pooja Lakshmin: Yes, absolutely. So Gemma is the first digital education platforms specifically dedicated to women's mental health. And it kind of is born out of my Instagram page at women's mental health doc, and then also my writing for the times, and that I've been doing over the past couple of years.

 You can take a class to learn how to have a vaginal delivery or to learn how to breastfeed or to learn how to sleep, train your kid. But there's nothing. For moms, there's nothing for mental health.

So I actually launched Gemma last year in the pandemic, which ended up being kind of the perfect timing cause everything was online. And what I really see is like Gemma being this big tent for women's mental health, for good quality evidence-based courses that you can take to learn how to. Deal with all the stuff that we've been talking about today.

And one of the things that we've seen with Gemma in the zoom classes is, you know, you get the videos, you get the recordings, you also get slides that have all of the citations for the research. So women who take the class, they share all this stuff with their partners. You know, and it's like this perfect frame to say to your partner, like, Hey, I just took this class.

I want you to watch this too. Or look at these slides or read this article, talking about sleep, you know, postpartum and how important it is. So like maybe we should have a conversation about what we're going to be doing for childcare. I think that really gives women and people who identify as women, the frame to have these conversations and impact.

Margaret: It's interesting because we've had a bunch of people say on our Facebook group or wherever this feedback of, I had my husband sit down and listened to that episode about this or that, because I think it really does help having kind of a new. Third party, rather than you sitting a spouse down or a partner down and saying, I need you to this, that, and the other thing entering into some sort of education from a third party that the usefulness of having this external source of education takes the flatness out of it in your partner.

And it also feels more 

Amy: solvable. I think this is a thing, this is a thing that other people go through. It makes it feel less huge. And also more solvable. I think if, you know, it's a framework that other people are finding useful at the same time. 

Dr. Pooja Lakshmin: Totally. That's actually one of the things that we just did around kind of user research from our customer base.

And that was the thing that kept coming out, that women were saying. The fact that somebody took the time to make this course means that it's big enough of a problem. That's not just our family. Right. And that is really validating and relieves some of this guilt and the shame. 

Margaret: Right. It's part of another I'm in the bad mom door and no one is here.

And then the minute you open that door, you're like, oh, everybody tour with me. Like there is literally no one. Who's like I'm over here in the great mob door. I don't know what y'all's problem. So who is, should come to Gemma, like who should utilize this? I'm sure it's everyone, but like what are people coming there to solve?

So, so 

Dr. Pooja Lakshmin: far it really has been women who are pregnant and are really looking to prepare for knowing how to take care of themselves. In that early parenthood journey, we have a good number of like second time moms. So moms who struggled with their, for after having their first and were like, I'm not going to do that again.

Let me put in place some structures and some safeguards. So, and then we also. A good number of folks who have been in therapy before, or maybe are still in therapy. And it has struggled with like depression or anxiety or things like that, but actually have used the courses as sort of, cause it's different.

It's not therapy. It's, we're providing kind of like all of that information and education. So it's almost like a great add-on to a therapy relationship that you can then take that knowledge and apply it to yourself in different ways. , I really want Gemma to be sort of this big tent for all these different moments in your life, in your twenties, when you're making decisions about school and careers and relationships in your thirties.

When you're thinking about having a family and maybe you're struggling with infertility or trying to get pregnant, that's something that I'm going through myself right now and it's own. Interesting journey. So, you know, we can use a lot of support there and then things like once your kids are older and like dealing with.

All of the transitions and difficult decisions that come with, you know, taking care of your own parents, taking care of your children, balancing your career. Right? So we really have exciting plans and big dreams for Gemma. Our website is Gemma women.com. I would love for folks to sort of follow us and there will be more to come and 

Amy: remind us about your Instagram account, because that's where I found you.

It's a women's mental health doc, 

Dr. Pooja Lakshmin: is that right? Exactly. At women's mental health doc. I focus a lot on, obviously women's mental health and, and I'm writing a book right now that will be coming out in 2023. So a while away this whole book writing process is one that is definitely American. Yes. Yes.

And the book is it's with penguin Rainer house, and it's called empowered, free yourself from the tyranny of self care and build true wellbeing. So it's really talking about a lot of what we discussed today in our conversation, like what is real self care. These are external problems.

So much of what I think about as a psychiatrist is like, what is the internal work that we do that can actually then change the system? While at the same time, not putting the burden more burden on ourselves that we need to be the ones that are changing the system. Trying to explore kind of providing tangible solutions for figuring out how do you have that conversation with yourself about letting yourself take the steak dinner from your neighbor?

Margaret: I'm doing it. I'm doing it. Can we do a whole 

Amy: course just on that. 

Margaret: I got to do a live stream and we're just sitting here eating steak and like, see, I did, 

Dr. Pooja Lakshmin: please have me back to that one. 

Margaret: Well, I feel like I needed to hear this conversation today and I love the way you frame this question in some ways that I haven't really thought about before.

We will put. To Gemma woman.com. We will put links to your Instagram all in our show notes so that you can follow up and learn more. Thanks for talking to us. Thanks so much for targeted to us 

Dr. Pooja Lakshmin: today. Thank you. .