The insufficiency of self-care

They say an ounce of prevention is worth a pound of cure. But what do you do when it’s too late for prevention?


The first panic attack hit me in bed. The second came while I was trying to read peacefully, at the advice of my therapist, in our dimly-lit guest bedroom. The third came when my husband and I were moving our ten year-old couch down the narrow hallway of our San Francisco Edwardian. I had to drop the couch and run to the bathroom, where I thought I would vomit. I sat in the corner and pulled my knees to my chest, trying to inhale slowly into lungs that felt like they had shrunk to the size of acorns.

“What are you doing for yourself?” A friend asked me recently. I paused, unsure what she meant. What was I doing for myself? I was having panic attacks, followed by sleepless nights. I was bathing in fear and waking up in hives. Years of an anxiety disorder combined with going off my medication plus a move and occasionally crippling Impostor Syndrome meant that what I was doing for myself was freaking out and then beating myself up for freaking out. “You know,” she said, “like taking a bath at night. Do you have a nighttime routine?” She recommended a brand of essential oil that she liked. “It helps me calm down when I’m feeling anxious.”

I turned the oil dropper over in my palm. What the fuck am I going to do with essential oils? I thought. I am having a crisis of some sort. I am angry. I am afraid.

There is a difference between anxiety and an anxiety disorder. The former is something that every human experiences — a sense of nervousness brought on by an understandably unpleasant circumstance. I have several friends who are pregnant; all are anxious about the pain of labor. Some people get anxious before they speak in public, because they are afraid they might stutter or forget their speech or perform poorly. The textbook example of anxiety is the “fight-or-flight” response a person might have to encountering a wild animal. That reaction begins in the amygdala, the brain’s emotional control center, and triggers the release of epinephrine (aka adrenaline) and cortisol, a stress response. This is the appropriate physical response to a threatening situation.

Sometimes, people have this physical response with no circumstantial threat at all. These are my people, people with anxiety disorders, people for whom fear is often in the driver’s seat. When I was 8 and 9, I had a recurring nightmare that I was in the backseat of a car driving down Diamond Bar Boulevard. Every time, just before I woke up, just as the car reached the Jack In The Box on the left side of the street, I would realize there was no one driving the car, and no one in front. It was just me. I was alone.

Being in the backseat of a car with no one driving is sometimes what anxiety feels like, although it also sometimes feels like many things, including:

  • Thoughts jumbling in your mind like a washing machine
  • A small bird living who has made your heart its cage and thuds against its sides with increasing urgency
  • The feeling that you are doing everything wrong
  • Nostalgia for when things were better. (Were things better? It doesn’t matter. In your mind, they were.)
  • A heart attack

I have been racked by severe anxiety in the last six weeks. I still have plenty of good days, and I am lucky that I have access to a combination of resources like medication, therapy, and a really supportive network of family and friends. That is what I need right now. A bath and a glass of wine are all well and good, but the concept of ‘self-care’ is anemic when it is reduced to something like that. Taking care of myself will require different things at different stages of life or depths of anxiety, and I also need to know when I need other people to help take care of me. Anxiety disorders my thinking; sometimes I need other people, and counseling, and medication, to properly re-order my mind. None of that falls into neat categories of self-care.

I keep holding onto the truth that there is meaning and growth in pain; some kind of participatory alchemy. There is work for me to do here, and taking care of myself is part of that work but so is challenging my anxious thought process. I might need a bath and an anti-anxiety pill and a conversation with a friend all on the same day; ‘self-care’ is too thin a concept to cover all of that. It is one weapon in a varied arsenal, or one flower in a weird bouquet.

To take care of myself is also to become more aware that other people need care, too. If I were to go through this period of acute anxiety and come out less empathetic, less compassionate, on some level I would not have done the work I needed to do. Where prescriptions for a bubble bath and wine are great, they are also all about indulging me and my need for comfort, which is okay and sometimes exactly right. But if I stayed in comfort forever, what kind of person would I be? I’ve tried that, and it doesn’t make me less anxious, no matter how soft the blanket I wrap myself in or how many hours of House Hunters International I watch. There is a time and a place for comfort, for indulgence, and then a time and a place for rigorous honesty, and for empathy, and for caring for yourself by getting outside yourself. That’s the work, all of it, and when you put it all together, the hope is you become more fully human.