Cheryl Martin (Host): You've probably heard the term self-care, but exactly what is it? Is it a selfish indulgence or necessity for our mental and physical health? Well, here to answer those questions and bust the myth of self-care is Isis Pettway. She's a Senior Clinical Therapist here at UAMS. Isis specializes in treating anxiety, depression, trauma, grief, and more so her clients are able to manage their daily lives with healthy outcomes.

 This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Cheryl Martin. Isis, so glad you're with us to discuss this important topic.

Isis Pettway, LPC: I am glad to be here. Thank you for inviting me back.

Host: So first, how do you define self-care and how does it influence mental wellbeing on a daily basis?

Isis Pettway, LPC: All right, so we've heard this term from our news outlets, um, majority, uh, social media as we have more conversations around mental health, mental wellness, mental illness, and different things of that nature. So the way that I define self-care is making sure that I'm basically, I'm getting those basic needs.

Am I eating? Am I sleeping? Making sure that I have those foundations. But for this particular medium, I want to use the World Health Organization's definition. The way that they define it, is so fitting and it gives a little more broader. So according to the World Health Organization, they define self-care as the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability, with or without the support of a health worker. And that is so important to recognize. Because a lot of the ways that we talk about self-care, we mentioned the interventions, but it's also important to recognize what self-care is in that perspective.

So I love the way that they say, Hey, it's the ability of individuals and families. Like this is how we're saying we're promoting health, we're trying to prevent disease. They also say, self-care recognizes individuals as active agents in managing their own healthcare. So that active agent part is so important because it's important that we know what we need and that we put the oxygen mask on first.

I always love the airplane analogy. Whenever you're flying, they ask you to, put your mask on first and then help the person next to you. So I love that term when they say an active agent in managing their own healthcare. And the way that we do that is through self-care interventions. And what that means is self-care interventions are evidence-based quality tools that support self-care.

So that's where therapy comes in. Your different medicines when you go to see your doctor, getting the diagnosis and being able to access those forms of health services and you want to be able to do this with and without a healthcare worker because at the end of the day, you are the active agent in making sure that your wellness needs are met.

Host: Great. Now this seems to call for being intentional, so how can simple daily routines, you mentioned like sleeping well or eating regularly, impact mental health over time.

Isis Pettway, LPC: Okay, so those daily routines, we have to say that word that a lot of us try to avoid. So the intentionality is where you have to develop the discipline. And if you've ever worked with a personal trainer, maybe a coach, they'll tell you that consistency and discipline are what make the difference.

And so that is what a simple routine can do. It helps to condition us to be in alignment for healthier outcomes. So there's data that says it takes 21 days to form a new habit. And so having that routine of saying, I'm going to bed at maybe 10, 11 o'clock every night, I'm going to be up around seven, or I'm going to bed at eight because I know I have to be up at four.

So developing those routines help you to be predictable as much as possible because we know that life happens and sometimes you have to pivot. But when you're in that routine, it helps you to have more focus. It helps you to develop that discipline and that consistency that leads to those outcomes. And so we know that, I don't know about you all, but when I'm sleepy, I'm not as focused and I'm not as present as I would need to be.

And so therefore, I may have some slipups in my job where, you know, in certain jobs you can't slip up because that could cause some issues that you don't want to get into. Sleep deprivation, you might be a little more irritable. You don't want to be bothered.

And so that can cause some friction in some places. And so with that, then we get into, well, this is when escalations in your stress levels and your anxiousness, maybe some escalation in your depressive symptoms, where you really don't want to do anything because you're tired, you're fatigued. And so, being in that routine helps you to care for yourself, helps you to pour into yourself, because now you have the gas.

You know, a car can't run on fumes and neither can we. So now you have those things where you're pouring into yourself to be able to give and to focus, into others because you've been taking care of you.

Host: So what about routines when it comes to eating?

Isis Pettway, LPC: Oh, absolutely. So with some of the tools we have these days, so some people set reminders, but again, if you are hungry, again, it's the focus and there's different research that says that, you know, even with kids in school, it's important for them to get breakfast. And same thing with us. And so same thing, I know that, my lunchtime is at this time, or if I have to pivot.

So do you need to pack a bag full of snacks? So when you're at work, you're able to stay in that routine? For some people they meal prep on Sundays so that they're able to have their go-tos. And so it is very important to have the fuel, because food is fuel that you need in order to operate day to day.

 Because when we start skipping meals and missing meals, that is sustenance that we need and it does impact you over time.

Host: What are some practical barriers that prevent people from practicing regular self-care? You talked about the discipline and the consistency.

Isis Pettway, LPC: Okay, so one of the reasons I love this question is when self-care has been presented in our society, it's sometimes presented in this very whimsical, I could talk about the way that it's been presented as luxury, but there are very real barriers to practical self-care. So as I said earlier, life happens and you may change work schedules.

Geographically, some of us live in areas where access to some services are not as accessible to others. And so, financial challenges. I may not be able to go to the spa, but I can make sure that I go get some fruit or some vegetables, to eat. Lack of being in a safe environment.

A lot of times when we talk about self-care, and I talked about the eight dimensions of wellness on the other podcast. But when you look at environment, that is a form of self-care because do you have sidewalks to take that walk, to exercise? Are you able to go to sleep at night and know that you are safe?

And so if I'm alert and if I'm up, I'm not sleeping. Lack of accommodations, for those who need them, who may have physical challenges or other challenges. Lack of childcare. Hey, I would love to go hang out with my friends and have that support, but I don't have anyone who can watch my kids.

And again, like I stated, just having those basic needs met. Do you even have healthy food accessible? Some of us live in grocery store deserts where we don't have access. We may have to travel a couple of miles, from home and we could get into lack of transportation and different things of that nature.

So, sometimes there are very much so barriers to self-care. More times than not, people are trying to just survive and just making it another 24 hours for them is self-care.

Host: Well, I think that ties in a great segue to my next question, and it is, so how can friends, family, or workplaces help support healthier self-care habits or encourage a person who really wants to practice self-care?

Isis Pettway, LPC: So support is going to look different for everyone. So the first thing I will tell anyone, friends, family, clients, is define what support looks like for you. Because what I have found in my work and my lived experience is we like to show up for other people in the ways that we would want.

And it's not about you, it's about that person. And so, friends, family, and workplaces can be supportive, by showing up in the way that that person is asking or need in their time. So it might be, your workplace, raising your salary or encouraging taking a mental health day. I've actually had a boss that did that for me.

They could see that I was drowning. I wasn't speaking up and she told me, she said, Hey, I need you to take some days off and I don't want to see you back, for a week. And I needed that. And so, just encouraging and having those environments in the workplace where people are not afraid to speak up and say, Hey, I need to take a couple of days off.

Because unfortunately, some of us do work in unhealthy or toxic work environments. And that in itself can be a strain, a barrier to self-care. Family and friends can ask that person, Hey, do you want me to run this errand for you? Do you need me to show up and help you fold laundry because it's all over the place and you feel overwhelmed?

I'll come over and help you fold laundry. Do you need me to come watch the kiddo or the kids for a second? And that takes courage and vulnerability as well. And that's a whole nother podcast episode.

Host: Is it acceptable to say to them what you need them to do or what you would like for them to do, or should you wait for your friends and family to suggest and offer?

Isis Pettway, LPC: The encouragement or what I usually share with my clients is ask the person, Hey, what does support look like for you? Now some people have that defined for them, and then some people don't know, or they may be so overwhelmed that they can't tell you at that time. And so if you are, again, read the room, kind of assess things, and it's, hey.

Do you want me to just come sit with you? Sometimes they'll be like, yeah, you know, so knowing the person is going to be key or knowing the situation. So if you are comfortable suggesting, go forth, but if you're not, hey, what does support look like for you in this time? Allow them to give you the feedback and then go from there.

Host: That's a great question to ask. So Isis, is self-care a form of self preservation or a luxury in today's society?

Isis Pettway, LPC: It's a bit of both. And I say that it's a bit of both, because we live in a time where, individualism is promoted, but also I'm seeing more drifting towards community care as well. So let me define that. So the way that it's become a luxury, and this is a lot of what we've seen kind of in the media, maybe through social media as well, self-care is a spa day or maybe taking this international trips. And it can seem like it's out of reach, which is why I do my diligence to let my clients know, Hey, self-care is, did you eat today? Did you drink some water? Did you take a deep breath? I've heard people say I didn't even realize I wasn't breathing.

Like I know I'm breathing because I'm alive, but I didn't realize my shoulders were clenched, or that I wasn't connecting to my body. And so it has become at times co-opted to be this things of luxury when in reality, self-care is not something to gate keep. It's for everybody because you can't give to others what you don't have in you.

And so if you are not taking care of yourself, it's hard to be present when you're depleted. Sometimes self-care is I need to go to bed, I need to go to sleep. I need to make sure I fix my protein shake tonight so it's in the refrigerator in the morning when I get ready to go because I know that if I've got kids, they may be last minute, but my protein shake is in there and I'm going to get my nutrients. Because little Johnny didn't want to get up this morning. And just asking yourself sometimes too, Hey, what can wait? Sometimes we tend to try to escalate things that can wait for 24 hours.

 So this project isn't due for another three weeks, I can get to it tomorrow. And I'll say that self-care is an act of self preservation because if you are not showing up for yourself, how can you tell others how to do that as well if you don't know it for you.

Host: So can self-care practices replace professional mental health treatment in some cases, or do they always need to work together?

Isis Pettway, LPC: They always need to work together. Always need to work together because what the professional mental health treatment does is it allows a space for someone to come in and acquire those tools of being able to sit with themselves and face themselves and say, this is what I need, because in my work, what I have learned is, sometimes it's the person being able to just sit in a space to really think about and focus on them. Because what I see a lot in the work that I do is I have put everyone else first and I don't know what I need or how to take care of myself. And so they work together. You come see me to gain the tools.

We collaborate on what works for you, what may not be working for you, and then you take these tools and you apply them to your everyday life to see, hey, this is working. I am noticing the decrease in my depressive symptoms, or I'm noticing a decrease in my anxiety, because I know now what I need to take care of me.

Host: Have you ever heard people say they sometimes feel guilty for practicing self-care? And if so, why do you think that is?

Isis Pettway, LPC: I hear it 24/7, and that's hyperbole, but I hear it all the time, especially from my clients that identify as mothers, as wives, I have to do everything for everybody. And then at the end of the day, I have nothing. And so I hear that so much around, well, isn't it selfish of me to put myself first?

 And so what happens is I end up doing a lot of identity work, around it's okay to pour into you. And what we look at is let's look at the evidence of what happens when you are not pouring into yourself and are you really showing up in a way that is beneficial or are you on autopilot and what has happened when you have not taken the time to step back and do for you so that you can do for others?

But that is probably one of, I'll say, top two, things that I hear when presenting that is, I feel guilty for putting myself first, or isn't it selfish for me to focus on me? So, yes, I hear that all the time.

Host: So what does self-care mean to you personally, and how has your definition changed over time?

Isis Pettway, LPC: So for me, self-care is making sure that I meet my essential needs and that is eating, going to bed at a decent hour to make sure I get my seven to eight hours of sleep, making sure that I get physical movement. Because I've been in a place where I've been depleted and tried to show up for others, and the outcome was not good.

And so, I read a quote by a poet and author, Audrey Lorde that says, "caring for myself is not self-indulgence. It is self-preservation. And that is an act of political warfare." I use that quote to remind myself that I cannot give to others if I am not okay, and when you try to operate out of a place of not being okay, all it's going to do is escalate the very things that you are really trying to work towards not doing, because you've not been sleeping, so you might be a little irritable or everyone's getting on that last nerve and now we're lashing out when the truth of the matter is you're tired, you're hungry, you're sleepy, because you have not been taking care of yourself.

So over time, it is something that I've had to grow into, especially as I get older, I have a 16-year-old as he gets older and when I do it, I model for him what care looks like as well.

Host: It seems like Isis, that a lot of this is about introspection as well for you to know exactly what you need because each one of us is different. And once you've had that conversation with yourself and know you, then implementing strategies for self-care.

Isis Pettway, LPC: You are right on the nail, Cheryl. That is absolutely correct. It is very much introspection and this is where when I have someone come see me, the first couple of sessions are spent really focusing in out, depends on the issues that they're coming in for, but if I've got someone who's coming in and saying, I'm tired, I'm fatigued. I don't have it to give. We have to look at, well, what have you been doing? What's been modeled for you? Because even culturally, we have to look at what has been tradition or what has been placed before you. And so if all you've known is the elders in your culture, if all you've ever seen is someone working, you've never seen someone model rest or self-care or anything of that nature, to what we know it as now. Now I know from my culture, sometimes it was, Hey, I'm going to go in my room for about 20 minutes, don't bother me unless the house is on fire. Now understanding that was Grandma's way of saying, I just need a little bit of quiet time.

I just need, some respite. But if that's never been modeled for you, then you do have to sit with that's all I've ever known. But it's okay to unlearn that and learn something new. And so it is absolutely going inside and saying this is what's okay. And you have to stand strong in that because you may get some pushback.

There's a quote that I heard from a poet once that said, " a car doesn't run on four flat tires," and it's true. We cannot run depleted. We cannot run hungry. We have to rest. We have to eat. It's important to have those relationships that align important to us as well.

Host: Isis Pettway, thank you so much. This has been so informative and an encouragement to really focus on self-care. Thank you for your insights.

Isis Pettway, LPC: Thank you all for inviting me back and I appreciate anyone who's listening right now, and I hope it helps you.

Host: I am sure it did. To make an appointment at the UAMS Psychiatric Research Institute, please call 501-526-8100. Now, if you found this podcast helpful, please tell others about it and share it on your social media. You may find other topics of interest to you when you check out our entire podcast library.

This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. Thanks for listening.