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When Does Self-Care Do More Harm Than Good?

Kelsey Tyler

Here are suggestions for practicing self-care: Take a bubble bath, make your own lip scrub, meditate, massage your face, eat chia pudding, dry-brush your skin, listen to tranquil music, mix a custom aromatherapy spray, get more sleep, go for a run, go on vacation. Hanging out with a friend and canceling plans with a friend can both be self-care. So can buying a $175 candle that promotes “cosmic health” (at least according to GOOP). Presumably, splurging on a self-care coach counts too.

Interest in self-care has steadily risen over the last decade. Google Trends shows search volume for the term peaking in autumn 2018. Right now, the self-care hashtag on Instagram calls up over 14 million posts, many of them inspirational quotes like “Everything will be so good so soon” and “Just hang in there & don’t worry about it too much.”

In its most basic definition, self-care means consciously doing something to promote your own well-being. There’s nothing harmful about proactively taking care of yourself. But many mental health experts have raised concerns that the modern-day self-care movement is masking a greater need in this country for professional mental healthcare. One in 5 adults in the U.S. has a mental health condition, according to the national nonprofit Mental Health America, and more than half don’t get treatment. Are people turning to self-care when professional medicine seems overwhelming, overpriced or just unnecessary?

“Self-help by itself, even evidence-based self-help tools for a particular condition, could do more harm in the sense that somebody could get sicker before they start to get better,” says Mental Health America CEO Paul Gionfriddo. “Mental health conditions are the only ones we wait until Stage 4 to treat.”

As a health concept, self-care dates back to ancient times. Whether it comes from Greek philosophers, early medical minds or generations of grandmothers with vernacular knowledge, the practice of augmenting or even replacing formal medicine with home remedies and good-for-you habits is woven into history.

More recently, self-care became a political act too. Starting in the 1960s and ‘70s, marginalized communities and activist groups spun self-care into a more radical movement. People of color and women invoked self-care to reclaim control over their health from a healthcare system that didn’t sufficiently serve their needs or respect their bodies. In her 1988 collection of essays, A Burst of Light, African American lesbian poet Audre Lorde wrote what’s since become a self-care battle cry: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

Lorde invented the battle cry. GOOP monetized it and bought it Instagram followers.

Self-care is also intertwined with wellness, which emerged in the late ‘70s as a holistic health philosophy in contrast to the anti-sickness focus of Western medicine. As Aisha Harris writes in Slate, academics promoted self-care as a way for emotionally taxed professionals, like social workers and trauma therapists, to combat occupational stress. To handle other people’s problems competently, the idea went, you need to look out for your own well-being first.

These countercultural influences are baked into the DNA of the self-care movement. But it’s hard to deny that today’s version of self-care has a capitalist sheen to it. Lorde invented the battle cry; GOOP monetized it and bought it Instagram followers. It can be difficult to see self-care for what it is and isn’t — to know when it’s an appropriate fix or a marketing grift.

Some self-care advice just encourages people — women, more often than not — to take time for themselves, without invoking clinical terminology or portraying DIY beauty hacks as valid therapy. But there’s also a lot of self-care content that directly addresses anxiety and depression, the first and second most common types of mental illness. (While these two issues are prevalent across the gender spectrum, women are still more than twice as likely as men to be diagnosed with depression or an anxiety disorder in their lifetime, according to public health data.)

“There’s a risk that people come to believe that they can handle these things on their own,” says Dr. Paul Appelbaum, a professor of psychiatry at Columbia University and former president of the American Psychiatric Association. “All of us face stresses in everyday life, and many of those stresses and their consequences can be dealt with effectively using a variety of coping techniques, and that’s fine. But when that feeling of being bummed out progresses to the point [where] it constitutes a set of depressive symptoms that actually interfere with life, when the anxiety gets to the point where it can be disabling, that’s a transition point.”

Of course, not everyone who’s practicing self-care or looking for self-care tools has a mental health condition. But if someone is aimlessly hunting for self-care listicles to make themselves feel better, perhaps without considering they might need more than a manicure to do the trick, it could indicate they need psychological help. For its part, Mental Health America offers free, evidence-based screening tools on its website — short questionnaires anyone can take anonymously to see if they are experiencing symptoms of depression, anxiety, post-traumatic stress disorder, addiction or psychosis. The surveys don’t provide formal diagnoses, but they can suggest next steps, like talking to a health professional or someone you trust.

“There’s some degree of self-care that’s involved when we’re talking about psychotherapy of any sort.”

This might feel like a big leap: All I wanted was a hot bath after a long week — now you’re telling me to take an anxiety test? But mental health diagnoses are still stigmatized; people might condition themselves to dismiss symptoms of illness as garden-variety jitters or sadness.

“We still have this fear of being discriminated against, of being treated differently if we open up about a mental health concern,” Gionfriddo says. Trying self-care rituals we read about online or in a magazine sounds more fun than doing the hard work necessary to address a deeper problem. Sharing self-care tips and memes can become a way to avoid discussing real depression, anxiety and other struggles. “The problem,” Gionfriddo says, “is when self-care delays someone from getting something way more effective, and so now they get sicker before the rest of us notice.”

Many practices that fall under the self-care umbrella are, in fact, evidence-based; research supports their ability to make a positive impact on health. Two prime examples are exercise and mindfulness meditation. “It’s difficult to make an argument against exercise, meditation or other relaxation techniques, sufficient amounts of regular sleep, a healthy balanced diet,” says Appelbaum. “All of those are good things, and many of them can help relieve the ordinary stresses of everyday life.” Some approaches to therapy encourage patients to learn relaxation techniques and then implement them on their own. “Therapy is always a partnership between the therapist and the patient,” he added. “There’s some degree of self-care that’s involved when we’re talking about psychotherapy of any sort.”

Access to care, however, is an obstacle for many people. Twenty percent of adults with a mental illness say they aren’t able to get the treatment they needed, according to a recent report. A number of factors can affect someone’s access to care, including where they live. Rural areas are among the most affected: In Alabama, there is only one mental health professional for every 1,260 people. Compare that to Massachusetts, where the ratio is one provider for every 200 people.

All I wanted was a hot bath after a long week — now you’re telling me to take an anxiety test?

Insurance coverage and affordability also create barriers. Even though most insurance plans are required to include mental health services under the Affordable Care Act, the Trump administration has dismantled certain provisions of the healthcare law, effectively steering more people toward barebones insurance plans that don’t have to comply with ACA standards. Furthermore, many mental healthcare providers still don’t take insurance.

“It’s hard for ordinary people to pay out of pocket for care,” says Appelbaum. “The system is a long way from being perfect, and that may contribute in part to a sense some people have that they need to handle it on their own.”

When people who need help are alienated from the possibility of professional care, clicking through hashtags, collecting comforting affirmations or researching which scented bath salts offer inner peace can feel like reclaiming a measure of control. But even with systemic failures by the medical establishment and social institutions, it’s still vital to recognize when to fight for the treatment you deserve.

“Sometimes,” says Applebaum, “the most important aspect of self-care is knowing when you can’t do it yourself.”

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