Psychotherapy Bulletin Editor’s Note: I want to again express my appreciation for all the contributions Dr. Jenkins has made to the Bulletin down through the years, and especially for this piece. It also feels important to acknowledge how much people with racial privilege, including myself, benefit from contributing to a culture in which it is difficult for a person of color to say “no.” Power disparities can lead to people of color and those with less privilege bearing a disproportionate load of the essential (but often unacknowledged) work within academia, scholarship, and other fields. Psychotherapy Bulletin and I welcome discussion of these imbalances—when we are part of the problem, we must be part of the solution.
Clinical Impact Statement: This manuscript delves into the author’s struggle with professional limit-setting and negotiating work-based obligations with his own personal self-care. Readers of this article will be presented with information to encourage those within the mental healthcare community to understand the ways in which their developmental history and identities can lead to appropriate or inappropriate limit-setting in regards to the work/life balance.
At times, I can be really bad at asking for help. This trait, for better or worse, is most likely a byproduct of a variety of factors in my life, most notably playing sports, my history of asthma, and my identity as a young Black professional. As athletes, we are conditioned from an early age to persevere and ignore thoughts of quitting or “taking a break” in order to be successful in our sport. Sport psychologists often highlight this athletic resilience as a tremendous quality for athletes to possess in order to progress in their sport and not get overly discouraged by injury or errors (Solomon, 2017).
This athletic resilience has served me well by assisting me in accomplishing great goals throughout my life, including playing collegiate lacrosse and running the Boston Marathon in 2014, though this type of resilience has also caused challenges in my life. Sometimes for me, as I am sure with other athletes, this resilience crept into the realm of “athletic bullheadedness,” which caused me to over-train and accidentally expose myself to either injury or emotional distress. The pull to be successful in my given athletic activities is a significant motivator for my perseverance when playing sports and this is something that can sometimes get overwhelming when I am dead set on accomplishing particular athletic tasks as the cost of injury or overtraining are high. Overtraining can have a huge impact on not only one’s physical health, but also on emotional wellbeing, causing lethargy and a lack of pleasure in activities similar to symptoms found in clinical depression (Kreher & Schwartz, 2012).
As I have aged, I have grown in my ability to distinguish between resilience and bullheadedness, but I still struggle at times with this difference when I am heavily invested in an athletic activity or goal. To address this concern, I rely heavily upon peers, trainers, and other athletes to assist me with maintaining proper perspective on my progress and both my physical and mental health. Over time, I have grown to trust their perspectives to make necessary changes, which has assisted me with fine tuning my own perspective of self so that I am now more competent with making more of those decisions independently. In addition to battling on the field with competitors, I had another opponent in my life, one that would challenge me every day: asthma.
Dangers of “Not Rocking the Boat”
Like many children with asthma, my life was an often-chaotic mixture of inhalers, “breathing machines,” and countless asthma attacks that would trigger trips to the hospital at all hours of the day and evening. I remember learning about the diagnosis from my pediatrician and being constantly reminded of my limits throughout my childhood. Having asthma makes the individual feel perpetually out of control, given the fear of the next upcoming asthma attack and the incomparable discomfort of being able to inhale but not being able to exhale, which is what people experience during an asthma attack (Van Lieshout & MacQueen, 2008).
As expected, these experiences are often scarier and more emotionally stressful for children when compared to adults, as children have fewer coping mechanisms to deal with these situations. I too was greatly impacted by my asthma diagnosis and the symptoms of asthma that I experienced as a child and continue to experience as an adult. The depression and lowered self-esteem explored in the research by Van Lieshout & MacQueen (2008) certainly was familiar to me, as I would remember thoughts and feelings that supported a sense of inferiority to my peers and shame over having a “broken body.” Even in the midst of an impending attack, I would frequently neglect telling my parents or teachers out of fear of missing out on an activity or being seen as “too needy.”
Children like myself may also feel uncomfortable alerting adults and caretakers about an impending asthma attack due to the stress that the incident causes for everyone. The child may instead avoid triggering the expected chaos initiated by signaling for help and attempt to deal with the symptoms, whether significant (or even in fact dangerous), alone. Unbeknownst to me, this was a common experience for many with asthma as many children experienced the mixture of anxiety about impending asthma attacks mixed with occasional defiance towards taking medication and having to miss out on celebrated childhood activities such as recess, gym, and so forth (Pemment, 2014).
Additionally, I foolishly believed either I could manage the attack or it would fade before becoming serious, and this flawed logic exposed me to ferocious and dangerous asthma attacks. Either through my own ignorance or misinformation, I admittedly never knew or internalized that people could actually die from an asthma attack until I was in college and a friend lost a loved one to an unmanageable asthma attack. This part of my identity cultivated a sense of not wanting to disrupt things or “rock the boat,” which has been a part of my personality ever since. This trait, mixed with the bullheadedness from sports, created a unique response to stress that requires me to be acutely aware of my circumstances and myself when stressful events occur.
When the Word “No” Is a Difficult Dialogue
Lastly, my identity as a young Black professional also contributes to my distinctive reaction to stress and the need for self-care. As I have previously discussed in other articles and venues, John Henryism and tokenism play major roles as influences in my life and experience of self. John Henryism, or the tendency for minorities to demonstrate almost backbreaking perseverance and positivity in order to “overcome” racism and find joy and status within society, is something that many Black males experience and something that has a significant impact on our mood. For many who are impacted by this mindset, giving into rest is considered surrendering to prejudicial stereotypes that label Black people lazy and incapable of having talent. This creates a situation where the person will avoid internal and external cues to engage in self-care and thus expose themselves to more opportunities for negative affect and physical consequences (Angner, Hullett, & Allison, 2011).
When I believe that I am in a state where John Henryism is corrupting my health and interfering with my workflow, I rely on perspective taking and being increasingly careful about analyzing irrational thoughts. Similarly, feelings of tokenism, where someone feels alone due to being the lone member of a community in an otherwise homogenous group, can promote Imposter Syndrome, or the feeling that one’s position at work or in the community was awarded, not because of the one’s talents, but because of one’s ethnic status and the need to fill a quota. There are times when these two societal stressors have a significant impact in my professional life. Although this impact has decreased in frequency and severity as I have been able to establish myself professionally at the hospital and experience more of the open minded humanity of my colleagues and coworkers, I still will on occasion get surprised by the return of these feelings at especially critical junctures, such as performance reviews or significant presentations. These stressors can make it difficult to ask for help from others because asking for help is perceived as a sign of weakness and incompetency when Imposter Syndrome and John Henryism are influencing your mind and self-care habits (Weir, 2013).
When preparing to write an article for the last edition of the Psychotherapy Bulletin, I was in a similar place of need. Events in my family had caused much stress and that stress was causing writers’ block the likes of which I had never experienced before. I would spend hours at the computer blankly staring at the screen waiting for words to pour out as they usually did, but nothing would happen and the computer screen would stare back at me, the blinking icon in Microsoft Word awaiting my keystrokes. During this period of time, I felt pressure from myself to continue producing articles for the Bulletin and a fear of letting my colleagues down who gave me the awesome opportunity to write for this periodical nearly two years ago.
The fear of disappointing these colleagues was tangible and it put more pressure upon me to produce a great article in the midst of my mind being a barren landscape where normally accessible mental, emotional, and intellectual resources had been sent to help cope with this family stressor and maintain my professional clinical obligations to my clients. But what was I to do? I could not disappoint my colleagues but I also could not produce an article out of thin air. Reflecting back on this experience a few months ago, I can now see how my various identities and experiences combined to create a sense of guilt for needing to say “no” and engage in the self-care of taking time off to be with my family. The bullheadedness that I developed as an athlete combined with how asthma contributed to a learned fear of being in a position of need further eroded my confidence to make me more susceptible to an episode of Imposter Syndrome and John Henryism. Contrary to conventional wisdom, I ended up allowing myself to struggle more than I needed to and I delayed enacting a self-care plan in regards to the article, which only served to cause further stress.
This experience allowed me to learn much about my apparent guilt of saying “no” and how I must be aware of how this tendency can continue to show up in my life. When I was able to finally convince myself to take a break, I felt an initial rush of guilt and then a flood of relief when I realized that I was now able to manage my stress at a reasonable and appropriate cadence. This situation provided me with the chance to take this stressor and convert it into a learning opportunity. To deal with the initial discomfort and guilt of saying “no,” I sought out articles on self-care and I spent time speaking to mentors and peers about stress management. This proactive reaction to this hectic incident not only proved to be beneficial due to the great information gained, but it also positively reinforced my own confidence in my abilities to be compassionate towards myself during times of need. This recalibration continues to today where I have revised my schedule in order to provide more time for consistent and meaningful self-care to maintain a more consistent level of balance as opposed to only primarily engaging in significant self-care when in times of stress.
This was a difficult article to write because speaking about your own self-care and how you needed help is not an easy topic for Type A people like myself (and you, too) to discuss publicly. Besides using this article as a method of further healing by speaking about my own experiences with stress and frustration, my additional hope is that this article can encourage us all to continue to have open and honest conversations about our own self-soothing and self-care. So, do not fear saying “no” if you really need to, no is often seen as a negative word in today’s society but it can also be one of the most compassionate words you can use towards yourself as it protects you from allowing physically and emotionally dangerous things into your life.
Cite This Article
Jenkins, J. (2017). The genealogy of my guilt towards self-care and saying “no.” Psychotherapy Bulletin, 52(4).
Angner, E., Hullett, S., & Allison, J. (2011). “I’ll die with the hammer in my hand”: John Henryism as a predictor of happiness. Journal of Economic Psychology, 32(3), 357-366. doi: 10.1016%2Fj.joep.2011.01.002
Kreher, J. B., & Schwartz, J. B. (2012). Overtraining syndrome: A practical guide. Sports Health, 4(2), 128-138. http://doi.org/10.1177/1941738111434406
Pemment, J. (2014, January). Asthmatic personality. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/blame-the-amygdala/201401/asthmatic-personality
Solomon, G. (2017). Overcoming performance errors with resilience. Association for Applied Sport Psychology. Retrieved from http://www.appliedsportpsych.org/resources/resources-for-athletes/overcoming-performance-errors-with-resilience/
Van Lieshout, R. J., & MacQueen, G. (2008). Psychological factors in asthma. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 4(1), 12-28. Retrieved from https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-4-1-12
Weir, K. (2013). Feel like a fraud? gradPSYCH, 11(4). Retrieved from http://www.apa.org/gradpsych/2013/11/fraud.aspx