The Psychology of Body Image: Why We Inherit Shame and Tools to Release It

Summary

Podcast Summary: The Tamsen Show

Episode: The Psychology of Body Image: Why We Inherit Shame and Tools to Release It

Host: Tamsen Fadal (Authentic Wave)
Guests: Dr. Shefali Tsabary; Dr. Mindy Goldman
Date: October 29, 2025

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Overview

This episode of The Tamsen Show explores the deeply ingrained psychological patterns behind body image, the transgenerational inheritance of shame, and offers practical steps for breaking free from toxic cultural scripts about women’s bodies, aging, and self-worth. Emmy-winning host Tamsen Fadal sits down with world-renowned psychologist Dr. Shefali Tsabary to dissect where our shame comes from, how it is passed down (especially from mother to daughter), and how modern women can reclaim their authenticity, self-acceptance, and intergenerational healing. The latter portion addresses menopause, breast health, and closing care gaps with Dr. Mindy Goldman.

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Main Discussion Points & Insights

1. Body Image: Where Shame Begins

• Inherited Narratives:

  • Shame about bodies, weight, and beauty is absorbed unintentionally from family, especially mothers and grandmothers, as well as society and media.
  • “It's insidious. It’s in the air we breathe, in our mother’s breast milk...in the way she holds herself in shame or in empowerment.” – Dr. Shefali Tsabary [01:42]

• Personal Anecdotes:

  • Tamsen shares a memory of her grandmother’s comments about her size and desirability to men, showing how these messages linger for decades. [03:43]

• Hormonal & Gendered Perspectives:

  • Girls’ self-esteem often ties to physical appearance because of social and biological factors (estrogen, oxytocin: “bonding” hormones) vs. boys’ achievement-based value systems. [04:42]
  • Girls become “healers and saviors”, trying to fix family anxiety by shifting attention to their own bodies.

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2. Generational Influence & Cultural Messaging

• Gen X and the Burden of Shame:

  • Gen X women are described as the “last truly oppressed” generation—raised to believe sacrifice and martyrdom were their duties, heavily affected by toxic media images and patriarchal standards. [11:29]
  • “We’ve really, you know, worn the cross as our second skin. We don’t carry it, we wear it.” – Dr. Shefali [12:38]

• Progress in Younger Generations:

  • Millennial and Gen Z women are better at living authentically, challenging outdated scripts, and less likely to internalize self-loathing.
  • Tamsen and Dr. Shefali both observe their daughters questioning and resisting legacy body shame and “diet culture.” [07:42]

• Media & Social Media Pressures:

  • The new challenge is hyper-curated social media branding and influencer culture, making artificial standards even more pervasive for today’s children and teens.

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3. The Psychology and Cycle of Self-Fixation

• The Ego Trap:

  • Although it appears we care what others think, body image anxiety reflects “the ultimate self-absorption...the illness of society.” – Dr. Shefali [00:52, 41:31]

• Health as the New Perfectionism:

  • Modern society’s obsession has shifted from thinness to “health,” but the compulsive, shame-driven energy is unchanged.
  • “The way we’re going after it is with that same lack and scarcity and desperation...so when you come at the problem with the same energy, it’s still the same problem.” – Dr. Shefali [26:27]

• Self-Acceptance as the Antidote:

  • Acceptance—not striving or fixing—is the “medicine.” True improvement must come from wholeness, not brokenness.

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4. Parenting and Breaking the Cycle

• Conscious Parenting:

  • The first step is awareness: realizing how unconscious cultural beliefs drive your self-talk and parenting. Own your story and openly discuss inherited patterns with your children. [14:50]
  • “The greatest gift we can give our daughters is our self-love and self-acceptance—not to say ‘I’m beautiful,’ but to say, ‘I’m all of it, and I accept it.’” – Dr. Shefali [35:31]

• Letting Go of Control:

  • Allow children to evolve beyond parental needs and expectations. The ultimate goal: “becoming irrelevant” to your child’s ego needs—giving them true freedom and sovereignty. [22:11]
  • "When you tell your children, maybe right now I'm not your person...we're not putting that pressure on ourselves." – Dr. Shefali [20:27]

• Ordinariness vs. Specialness:

  • Encourage self-worth in “ordinariness,” not specialness or achievement. Overemphasis on being exceptional breeds anxiety and fragility. [45:56]
  • “Please teach your children that, yeah, they’re unique, but they’re not special…” – Dr. Shefali [44:42]

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5. Gender, Power, and the Roots of Comparison

• Evolutionary Perspective:

  • “We [women] are meant to be the choosers, not the chosen. But toxic patriarchy made us be chosen, reversing our biological role.” – Dr. Shefali [52:30]
  • Internalized oppression leads to women competing with each other and themselves, perpetuating powerlessness.

• Rising Above Competition:

  • The way forward is radical sisterhood: dropping competition, shame, and artificial standards.
  • “When one woman speaks her truth, it liberates the men in her life, the children in her life, and gives everyone permission to fail.” – Dr. Shefali [38:05]

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6. Midlife, Aging, & Menopause—Owning Change

• Changing Bodies and Cultural Resistance:

  • Aging provokes a panic to “reverse” the changes. But doubling down on self-fixing defeats the true gift of this era: no longer needing outside approval. [47:36]
  • “If we obsess...if we believe that we are less than...we are sabotaging our own highest potential. The gift of this age is to finally release the need for others’ approval.” – Dr. Shefali [47:46]

• Letting Go of External Validation:

  • Dr. Shefali shares her grandmother’s liberation from mirrors and weighing herself as a metaphor for internal worth. [50:28]

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7. Medical and Practical Aspects of Menopause (with Dr. Mindy Goldman)

• Perimenopause & Menopause Symptoms:

  • Not just hot flashes: also dry mouth, constipation, palpitations, joint pain, and more.
  • Importance of not letting menopause symptoms overshadow regular breast health screening, given the increased risk after age 50. [59:49]

• Hormone Therapy Myths & Realities:

  • The vast majority of women are still wary of hormone therapy, but evidence now supports its safe and effective use for most when started soon after menopause. [60:59]

• Proactive Midlife Health:

  • Know your risks (family history, lifestyle), prioritize regular screening, and seek expert advice.
  • Exercise and minimizing alcohol both reduce breast cancer risk.

• Empowerment:

  • "Do not accept that you have to suffer. We have effective treatments for virtually any symptom that people are experiencing during midlife." – Dr. Mindy Goldman [73:45]

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Notable Quotes & Memorable Moments

• On Generational Healing:
  “The millennials and Gen Zs are right to criticize us and scold us...they scoff at us for living in the cage for too long, but they don’t understand that we were breaking eons of heavy messaging that brainwashed us.” – Dr. Shefali [12:38]

• On Passing Down Shame:
  “It’s in the way your mother holds herself in shame or in empowerment. You want to fix her, so you save your parents by sacrificing yourself.” – Dr. Shefali [04:42, 06:45]

• On Health Obsession:
  “I see myself doing health in the same way I did disease...with the same attack mode.” – Dr. Shefali [27:17]

• On Ego and Body Image:
  “Even though it appears that we care what other people think, it’s actually the ultimate self-absorption.” – Dr. Shefali [41:31]

• On Aging and Acceptance:
  “Every day I see changes...the main gift of growing older is not to cling to youth...but to finally release the need for others’ approval.” – Dr. Shefali [47:46]

• On Men Supporting the Patriarchy:
  “You walk into a party—the men are fat and balding...they don’t put on face cream, they haven’t even combed their hair. Why is that? Because we fell into the trap.” – Dr. Shefali [54:17]

• On Sisterhood and Reclaiming Power:
  “When we rise in sisterhood, in sorority, that is how the power changes.” – Dr. Shefali [55:38]

• On Medical Empowerment:
  “Do not accept what people have been saying for years. Whether you’re a healthy perimenopause patient, going through or gone through breast cancer—it is not true that you have to suffer.” – Dr. Mindy Goldman [73:45]

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Key Timestamps

• [01:42] Body image beliefs: transmission from mothers/families
• [04:42] Self-worth, gender, and body perception
• [12:38] Gen X women and martyrdom; breaking cycles
• [22:11] Parenting: letting go and “becoming irrelevant” to ego-needs
• [26:27] Health fixation as a new form of shame
• [35:31] How mothers’ self-view shapes daughters
• [47:36] The body's changes in midlife: acceptance, not war
• [52:30] Evolution, gender power, and “the chosen” vs. “choosers”
• [55:38] Sisterhood as the path to empowerment
• [59:49] Menopause and breast health
• [60:59] Hormone therapy myths
• [73:45] Reclaiming agency in midlife health

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Actionable Takeaways

• Question inherited beliefs: Become aware of the “scripts” you’ve received about bodies, worth, and womanhood.
• Practice self-acceptance: Improvement must come from a place of wholeness, not self-fixing from shame.
• Break the cycle: Talk openly with daughters and sons about toxic cultural patterns. Model self-acceptance.
• Build sisterhood: Drop competition and comparison; support other women’s authenticity.
• Own aging: Release striving for external approval as you age; celebrate ordinariness, connection, and self-worth.
• Seek proactive perimenopause/menopause care: Know your risks, prioritize both symptom management and screening, and demand informed, evidence-based care.

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Closing Thoughts

This episode is a clarion call to question every inherited, shame-based belief about our bodies and to move, both as individuals and as communities of women, toward self-acceptance, conscious parenting, and authentic empowerment. Whether battling the inner critic, facing midlife changes, or navigating menopause, liberation begins with honest self-inquiry—and continues when we join together in solidarity rather than competition.

For more, follow Tamsen and Dr. Shefali, and check out Dr. Shefali’s A Radical Awakening as well as medical resources on midlife health.

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End of Summary

Transcript

[Dr. Shefali Tsabary]

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[Tamsen Fadal]

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[Dr. Shefali Tsabary]

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[Tamsen Fadal]

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[Dr. Shefali Tsabary]

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[Tamsen Fadal]

Emoji moment from Sadie who writes I'm not crying, you're crying. This is what I said during my first appointment with my physician, Mochi, because I didn't have to convince him I needed a GLP one. He understood and I felt supported, not judged. I came for the weight loss and stayed for the empathy.

[Dr. Shefali Tsabary]

Thanks Sadie.

[Tamsen Fadal]

I'm Mayra Amit, founder of Mochi Health. To find your mochi moment, visit joinmochi.com Sadie is a Mochi member, compensated for.

[Dr. Shefali Tsabary]

Her story if you ask me give a diagnosis I would say we have become insanely delusional, deranged, obsessed with our own ego and this is the illness of society. Even though it appears that we care about what other people think, it's actually the ultimate self absorption. This is where we're heading. We're living in nuclear families. We are talking about our children. We care about our social media account. It's a mass obsession with something that is designed to disconnect you.

[Tamsen Fadal]

How do you unlearn it? How do you unlearn something like that? Dr. Shefali is a world renowned psychologist recognized globally for challenging the modern myths that keep women trapped in perfection and self doubt. My grandmother, I remember her talking to my mom and saying Tamsin is too big for her size. She's got to get smaller for men to like her. I remember that even to today when.

[Dr. Shefali Tsabary]

I look at a size, it's insidious. It's in the air we breathe, in our mother's breast milk. It just in the way she holds herself in shame or in empowerment, how she looks at herself in the mirror. Because we have estrogen and oxytocin and we're bonders and we're connectors. We care about what people think about us more perhaps than the average boy just because of that bonding hormone. We're sensitive. So if we're seeing that our mother is not happy with how we are, our inner caretaker vibrates with anxiety, with anguish. We want to fix it. Now the focus is on health. But the way we're going after it is with that same lack and scarcity and desperation like I gotta have my creatine and I gotta build muscle mass. So when you come at the problem with the same energy. It's still the same problem.

[Tamsen Fadal]

Hey, everybody. Welcome back to the Tamsen Show. So I want to ask you this question. When did you first learn how to talk about your body? Maybe it was a parent that said, you know, you got to watch what you eat, or you overheard your mom call herself fat in the mirror. Or maybe it was a coach that said, maybe you'd be better if you're just a little bit smaller. Most of us didn't invent these ideas about ourselves or these feelings. We absorb them from the people who raised us and the culture we grew up in. And without even realizing it, we may be passing the same patterns down to our own kids. That's why I wanted to have this really important conversation with Dr. Shefali. Her work has helped millions and millions of parents all around the world. Her best selling book, A Radical Awakening, is gonna teach you to break free from societal expectations and really rediscover the person you were always meant to be. I love hearing her talk, and I'm so exc. Cause she's giving us the tools to break these patterns, not only for your children, but for yourself as well. Let's go ahead and get started. Dr. Shefali, it's so good to see you.

[Dr. Shefali Tsabary]

Oh, my goodness. A dream, dream, dream come true.

[Tamsen Fadal]

I feel like that, too. I have been a fan of yours for a very, very long time. And when you said yes, I was excited that you were gonna be here today. Of course, talking about, what I was just saying is, you know, how we get these beliefs. I was thinking about it, thinking about you coming here today and thinking about something that I hadn't remembered in a long time. My grandmother was always about women's body. She was in the fashion world, clothes, everything was about clothes. And I remembered it was a story that came up when I was researching all of this. I remember her talking to my mom and saying, tamsin is too big for her size. I was 16 at the time. She's going to be a woman size four. She's got to get smaller for men to like her. And I don't think she ever thought she was saying anything wrong. This was the time. But I remember that even to today when I look at a size on a ticket. So everything that you're saying is so right on about our belief system and ourself.

[Dr. Shefali Tsabary]

And it's insidious. You know, it's in the air we breathe, in our mother's breast milk. It just in the way she holds herself in shame or in empowerment, how she looks at herself in the mirror. You know, all my life I was told, oh, you know, she's so cute. She's so sweet, you know, pretty. Oh, but she's just too fat, too plump, too this. And when we girls at a young age begin to realize that our self esteem, our value, our worth is tied into how we are perceived as by the other in terms of beauty, in terms of, you know, size, we then attach to it because we think, oh, yeah, you know, and this may not be too different than how a boy may attach to his. I was wondering about that athleticism or his earning capacity. So boys are not exempt from this, you know, extreme focus on how we are, what we do, our achievements or how we look. But I think for us, because how we look is genetic. Yeah, it's just what we were born as, for the most part, it becomes so treacherous, right? Well, we can change, or I can change my career or I can work harder. There's nothing I can bloody do about my. The way I put on weight or the way my nose looks or the way my face is shaped. And so for a girl, it becomes more treacherous, right? And our self esteem, the girl's self esteem, because we have estrogen and oxytocin and we are bonders and we're connectors. We care about what people think about us more perhaps than the average boy just because of that bonding hormone. It matters to us. We're sensitive. We like to take care of people. So if we're seeing that our mother is not happy with how we are, our caretaker, our inner caretaker vibrates with anxiety, with anguish. We want to fix it. We're fixers. We're healers, we're saviors. So then we save our parents by sacrificing ourselves, right?

[Tamsen Fadal]

When did you start looking into this and say, like, this is something we've really gotta dig down deep and pay attention to or otherwise this pattern's gonna continue and continue.

[Dr. Shefali Tsabary]

I have been suffocated in the, you know, in the cage of toxic patriarchal messages. So it's been a personal battle cry. But then watching my sisters, watching my clients, my female clients suffer at the hands of this. And now I have a daughter. And it's so hard to, you know, be realistic about health and toe the line about data and science and weight, but not shame, right? She calls me an almond mom now. You know, that's the thing that I.

[Tamsen Fadal]

Had to get a definition of it. I think I was late to the game. I didn't know.

[Dr. Shefali Tsabary]

Yeah. See, our generation really grew up with an excessive focus on our outer appearance. I mean we have been done a number with our generation, right?

[Tamsen Fadal]

I agree. I always wondered if it was just me and then no, no, no.

[Dr. Shefali Tsabary]

Gen X. Yeah. We have poisonous, treacherous messages that the millennials and Gen Zs are right to criticize us for and scold us. My daughter's always scolding me, mom, you're not, that's not healthy, mom. And I'm like, oh yeah, you're right, I need to be checked. Because it was just the way we, that we should be skinny, we should be always looking at our weight and criticizing ourselves. And we are self loathing almost. We are. And it's a cycle, it's a cycle, it's a spiral. And I love watching my daughter and her generation not have this inner chatter. And I'm like, what, you don't think about food and what you're putting in your body and do you? Don't punish yourself for eating the chocolate cake. Like you're just okay eating it.

[Tamsen Fadal]

Wow, isn't that fascinating? It really.

[Dr. Shefali Tsabary]

I would torment myself and I would go on a cleanse the next day, right?

[Tamsen Fadal]

Like I, for hours or days. There might be a punishment.

[Dr. Shefali Tsabary]

Punishment. While I'm digging into the cake, I have to say, oh, tomorrow I'm going to go to the gym. Like there has to be something, some compensation, some guilt. Like that is self punishment, that is loathing. And I love how my daughter will just eat it and have no commentary.

[Tamsen Fadal]

When do you think the awareness of bodies starts to happen, especially for girls?

[Dr. Shefali Tsabary]

Is that six or six, seven, eight? You know, it just depends on the environment. But even if you have the most conscious mother and transparent culture will do a number, you know, our media, you know, watching these airbrush filtered, you know, polished images and now with social media where I feel insecure looking at all these airbrushed models constantly showing up in my feed, I can only imagine how susceptible a 9 year old girl is, right? Who hasn't yet understood that this is, you know, artificial, this is superficial, this is not reality, this is fake. I have to keep combating those images and telling myself no, no, no, this is not real. Just come back to ordinary life and be okay with your ordinariness. Imagine what the nine year old girl is up against today, right?

[Tamsen Fadal]

I can't in some ways because you know, I have a nephew who's 14 and so he's a boy, so maybe it's a little bit different. But even with him I see that, you know, the constant reel, you know, I hear it and See it. But you're right, I look at that stuff and I do have to try to bring myself back to reality and dissect it a little bit from my brain so I can be settled with it and realize that's not all true. So I can't imagine how difficult it must be for a really young girl and then for parents that are dealing with this too.

[Dr. Shefali Tsabary]

And that's why the parent has to be so on top of their game today to combat the toxicity of the messages that our children are, you know, ingesting. Because children are gullible, they're naive, they're trusting, they can't even perce. See for a second that they're being manipulated by a, you know, commercial marketing, you know, angled world that has an agenda to make them depressed and anxious so that then they are on medication and are part of the system. They can't fathom that. They can't fathom this evil of the commercial industry and the business of social media. So we have to be up on our game to shield them from this and really protect them and speak out against the artificiality, the superficiality, and also make sure that we are walking around in our ordinary cellulite, wrinkled bodies with ease. We don't have to, you know, keep talking about how much we love ourselves. We just have to accept ourselves. Right? And self acceptance is the best kind of medicine that there is.

[Tamsen Fadal]

You brought up Gen X, and I think it's really important and we know it's impacted Gen X in particular. Why do you think it's been that generation, do you think? Because we had a little bit more media and a little more conversation about it than other generations?

[Dr. Shefali Tsabary]

Well, I think we were coming out of the boomer generation that was, you know, post war, you know, just struggling. The woman was finding her identity. She was going to work for the first time, you know, in that period and discovering who she was, but still heavily under the chains of an unscrutinized patriarchy. Right? And the MeToo movement has only just come about where women are finding their voices, and now we're rallying with each other and we're, we're seeing each other on social media in a new way and we're, we're owning our power in a way that we perhaps have never had the ability to do. So Gen X was the last generation of the really oppressed woman, our generation.

[Tamsen Fadal]

I so agree with you. And I think sometimes I look and I go, oh, well, that was a long time ago and we should be. But it really did have Quite an impact. And I can imagine. You know, I'm not a parent myself, but, you know, I'm around young girls all the time. I consider myself a mentor to young women. And I look at it a lot from, you know, from where, from my vantage point. How does it translate into how Gen X women parent? Because I have to imagine that can be very much a struggle.

[Dr. Shefali Tsabary]

Yeah. And that's really the women I help. And of course, millennials. But Gen X women have had messages of sacrifice and martyrdom and, you know, feeling tremendous guilt for every decision we make, where we put ourselves first. I mean, we've really, you know, worn the cross as our second skin. We don't carry it, we wear it. And we are breaking. When I wrote this book, A Radical Awakening, just five years ago, it was a wake up call. And so many women are so grateful to me for having written it. Although it should. Like, if a Gen Z picks it up, they'd be like, yeah, I know this, but they don't understand or do this all the time, but they don't understand that we are the generation that helped break the shackles. Right. And the millennials are now coming forward. They paved the way for the Gen Zs, but it really began with women like us. And we're breaking new ground. And now we've allowed the generations to have this force within them and that they scoff at us for living in the cage for too long, but they don't understand that we were breaking eons of heavy messaging that brainwashed us and we had to wake up and we had to, you know, smell the roses and say no. And we were terrified to say no because we weren't given the permission for.

[Tamsen Fadal]

In every area. In every area, whether it was within a relationship in a workplace, saying no to a aggressive boss or don't touch.

[Dr. Shefali Tsabary]

Me or don't touch me or touch more or we were not allowed to say no more. And so now it's such a pleasure to watch the next generations carry that inner sovereignty and authority with such aplomb, as if, you know, they always. They have no idea what we had to go through to allow them to do this.

[Tamsen Fadal]

I am so with you and so proud that we've gotten to this place. But I do have to check myself a lot. Like you were saying that every once in a while I have to remind myself, don't be like that about yourself. Don't say that about yourself. If there's a parent out there that's listening, saying, like, yeah, I grew up in that. I'm Gen X. But I'm trying to make sure that I'm not passing this on to my daughters or sons. What is the most important thing to do?

[Dr. Shefali Tsabary]

I think just this awareness of our cultural toxic belief systems. Become aware of how we grew up and then try to not pass that down and own it, right? So I tell my daughter, you know, every time I'm a martyr, right? I left my country. Look what I've given you. I tell her, okay, I need to sing my own praises a little bit because you're not giving me any acknowledgment.

[Tamsen Fadal]

So she taught you to do that?

[Dr. Shefali Tsabary]

Oh, my God, yeah. And to own my story. She'll tell me, mom, yes, you left your country, but I grew up here. You cannot put your immigrant burdens on me, right? And I put them on her very lavishly, but I'm just conscious of them. So I think just becoming conscious that it's a different era. Not to be afraid of the, you know, Gen Z is another fantastic, you know, cultural shift that our generation doesn't understand. And sometimes we get. We roll our eyes, you know, every generation likes to do that, of course, but they are becoming just better and better at owning their truth. They are not here to be slaves. They're not here to not live in their power. They. To waste their life on just sacrifice. I love that about that generation. However, they can be a little bit fragile, they can be a little bit entitled, but we have to just see them for their beauty and not be so scared of them and not create this chasm. You know, it's very typical for the older generation to go, you know, we were never like this, and look how spoiled they are. Every generation thinks the next generation is so entitled because every generation is giving so much to the next generation. We have given them the cell phone, the Netflix, the Uber Eats. So when they're sitting on their butt and ordering and stuff comes onto the door and we're like, oh, my God, we had to ride a bicycle. We had to save our allowance, and.

[Tamsen Fadal]

Our parents told us we had to walk 20 miles exactly.

[Dr. Shefali Tsabary]

This is not their song. This is not their song to sing. This was our song. And we have to let go. Romanticizing and staying in this nostalgia of how things used to be, it isn't. And we shouldn't romanticize how it used to be either.

[Tamsen Fadal]

What do you do instead? Because I think you're right. It's. It's. Every once in a while you want to go back to that safe space. How we romanticize it, because it's scary. Change is scary, period.

[Dr. Shefali Tsabary]

And we don't recognize. We didn't grow up digitally. So we are not savvy. We don't understand the language. We don't get how comfortable our children are making friends across this texting space. So we criticize the minute something is unfamiliar. Right? It's kind of xenophobic of us. We criticize. So now we criticize that generation. And in doing that, we lose touc. And they don't appreciate that. And they will alienate from us because all they see in our eyes is this. You know, like, who are you? We don't understand you. But instead of trying to understand them, we shame them.

[Tamsen Fadal]

Do we do that in the workplace and at home, too? I have to imagine that because we have intergenerational workplaces now, too, that you hear somebody go, oh, Boomer. Or somebody else going, oh, you're a millennial. And I hear it every once in a while. It took me a while. Like, what's the definition of all these things? What are the traits of each person? But, yeah, I see it all the.

[Dr. Shefali Tsabary]

But it's because the generations are shifting so fast. It's in one way, they're artificial labels. They're just names, of course. But there is a truth in that, because we are sweeping through errors so quickly, right? Technology is changing so fast that we can really define the era. And we shouldn't get stuck on the label and use labels to distance ourselves, because that's what we're doing. And mostly our generation does it for the younger generation because we're like, oh, look at these kids. They're so entitled. Who do they think they are? But I think what we need to do is create a true bridge and an allyship and an understanding, but also communicate with them that you are speaking an alien language. I don't understand you. I say that to my daughter. I don't get you. Like, I don't understand your values, and I don't shame myself for it. I understand that you are growing up in a completely different context that I will never touch. And good for you. But you need to understand where I'm coming from, and I need to understand where you're coming from. And we may never meet in the center, but we. We just need to respect where we are at. And I think that's what parents do wrong. We try to get the child to agree with us, to endorse us, to, you know, capitulate to us. No, we need to have a healthy respect that we may never bridge this.

[Tamsen Fadal]

Chasm and that's okay.

[Dr. Shefali Tsabary]

And that is okay.

[Tamsen Fadal]

Yeah. I love that lesson because I think that that's important and not feel like we failed if we didn't make this perfect union of everybody agreeing with everybody else. Because it's not gonna happen.

[Dr. Shefali Tsabary]

Yeah. I just spoke with a mother the other day, and she was so guilt rid because she's like, you know, I just don't like being around my son. And he's in his 20s. Right. And she was so tormented with this guilt. And when she saw compassion and complete acceptance in my eyes, she was like, you're not shaming me. And I said, because in which playbook does it say that we have to stay in this enmeshed kind of entanglement with our adult children, and they should stay in reverence of us. It's okay for us to not be each other's men match, but we eternally are in love. We're always loving. But we can, you know, tell our children, I may not be your person anymore, like the tribe that you come to for solace, because everything I say makes you upset.

[Tamsen Fadal]

My breathing is on a constant. My breathing.

[Dr. Shefali Tsabary]

Yeah. So I get that I'm not your person anymore, but, you know, we can always have this loving devotion for each other. But we set our children free, and we set ourselves free from being the person our children need to come to. Because when we put that pressure on ourselves that you need to come to me, I'm your mother. That is a deep illusion and a trap we fall into. And we actually keep our children enmeshed with us. We keep in guilt and shame trying to become something we're not. But when we set each other free and we tell our children, you know, maybe right now I'm not your person, but maybe in a decade you'll come back, or I'll become more evolved to be in your exalted presence. But we're not putting pressure on ourselves.

[Tamsen Fadal]

I wonder if we see in time that those relationships form differently.

[Dr. Shefali Tsabary]

Respect the minute you allow breathing space and you accept the isness of whatever's happening in whatever relationship, if you and your partner are just not sexually attracted to each other and there's no chemistry, instead of fighting it, you allow space. It's the complete opposite of what your instinct wants to do. Your instinct wants to control it, fix it. But you learn through meditation to allow space. Now we see what will evolve. Maybe we'll come back together, but maybe something else will come. And that is scary for people, but that is life. And life is forever in the unknown. But we are so scared to lean into it. And when you become a parent, you double down on control even more because you know, or your ego thinks that their happiness is your happiness. So you're like, I gotta control this situation because if you go off, I go off the cliff, right?

[Tamsen Fadal]

And that I don't have control anymore.

[Dr. Shefali Tsabary]

And I'm gonna die, right? So that enmeshment is the toxicity of parenting. And that's what I teach, is to release your children. And parents like Rebel, they argue with me. They're like, what do you mean? You know, when I say things like, your goal is to become irrelevant for your children, they're like, irrelevant? You want me to be irrelevant after I've spent half a million dollars, I gave up my body, my soul, I could have been a, you know, a neuroscientist. And I gave up that career. And you want me to be irrelevant. But what I'm saying deeply is to allow space, is to give, give the freedom for each one to emerge into our own sovereignty. And that's been the missing piece, right?

[Tamsen Fadal]

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[Dr. Shefali Tsabary]

Now the focus is on health.

[Tamsen Fadal]

Yeah. Is that better or no?

[Dr. Shefali Tsabary]

No. It's just an out of focus. Right. Is what we're calling it now. It's like a positive psychological term. It's health.

[Tamsen Fadal]

Got it.

[Dr. Shefali Tsabary]

But the way we're going after it is with that Same lack and scarcity and desperation. Like I gotta have my creatine and I gotta muscle mass, build muscle mass and I gotta, I got to. So when you come at the problem with the same energy, it's still the same problem, right?

[Tamsen Fadal]

So we think young women are gonna hear that too.

[Dr. Shefali Tsabary]

I think women are seeing us doing it with such a fervor and I hope that they unshackle the chains of that desperation and come to it with self acceptance and ease and rest. You know, I see myself doing health in the same way I did disease. You know, it's just with the same attack mode.

[Tamsen Fadal]

I see what you're saying.

[Dr. Shefali Tsabary]

And when you come at something with a desire to fix because you see it as broken, whether our children, our partners or our own health, when you come to it with that ferocity, it's actually you're still in the same, you know, you're still draining, you know, you know, circling the same drain. You're still around that same problem and you're not coming to it with a fresh perspective. So what is the fresh perspective that you want to give your children? That you first accept all of who you are with a true celebration and an honor. And then you can lean into improving, but you can't be going to the improvement out of a sense of brokenness. You have to lean into the improvement out of a wholeness. And that is the missing piece. And we're still missing it.

[Tamsen Fadal]

It's very hard, right? I mean, what do you do to get to that? Because I think about, maybe you didn't have a parent that criticized you, but maybe you heard them criticize themselves and what that does to you.

[Dr. Shefali Tsabary]

It's that inner voice. It's combating and taming, but first becoming aware that you have an inner voice that you've inherited from culture and your parents perhaps. And that's not your true self. Your true self, which is there within us all, is truly okay with who you are. Your true self is good. Your true self is at rest. Your true self is like a child's true self. Right? A two year old is not thinking, I'm not dark enough, light enough, my hair's not curly enough. The two year old is in presence, in attunement. That was our original destiny till we got off track through culture, scarcity based messages that brainwashed us into, into self loathing so that we could buy everything we needed to fix ourselves. So that's our model. Fix it, fix it. It's broken. I mean, it's really bad business if we all walked around feeling good about ourselves. Like there's no business.

[Tamsen Fadal]

There's no business left.

[Dr. Shefali Tsabary]

People won't be tuning into us either. Right. Because they're good.

[Tamsen Fadal]

Right?

[Dr. Shefali Tsabary]

Right. They're in nature. They're under a tree.

[Tamsen Fadal]

They don't need anything.

[Dr. Shefali Tsabary]

They don't need anything. They're whole. And that is our destiny. That is our truth. That is our authentic truth. So all of this, you know, come on, let's do this is a lie. It's actually a mask we're wearing because we're deeply disconnected. And what I'm talking about is deep stuff which can only come about when you truly go on a journey of inner solitude and inner healing and take it upon yourself to bridge this inner cast. Because no one's going to give it to you. Well.

[Dr. Mindy Goldman]

Right.

[Tamsen Fadal]

And the world is moving so quickly right now. How do you take that time to get quiet?

[Dr. Shefali Tsabary]

Yeah. Because you see the fast trains and realize this is the machine of the Matrix toward a gutter. You have to see where this is going. You can't buy into it. And all my work is about deconstructing the cultural paradigms. All of it defiantly and boldly and provocatively. And people don't like it when I do them. I don't have a popular message. It's not entertaining to constantly have to examine the bullshit that you've inherited. Right. We don't wanna do that work. It's terribly inconvenient because then you begin to speak in truth and people don't want truth.

[Tamsen Fadal]

It's because you can't go buy the work. You can't go. You gotta do it.

[Dr. Shefali Tsabary]

You gotta do it. And it takes critical thinking. It takes defying the Matrix. It's being willing to get up from the table and say, I don't agree no more. I'm not buying into your lies. Walking away from people even though you know they're the popular crowd speaking for the oppressed. It takes a lot of courage to do all this work. But if you don't, you'll be swept away by the crowds. Yes. You may belong in that popular. Yeah, but it's not a true inner connection. It's just a fake, momentary sense of belonging.

[Tamsen Fadal]

Do conversations like this, especially when we go back to body image do they show up in different cultures differently, do you think? Or do you think at this point?

[Dr. Shefali Tsabary]

I think we're all swept by the Western imperialist mindset of what beauty is and what a body looks like, you know, and what features are valued and prized. And it is the Western model. Right. It is white, skinny, blonde, blue eyed. I mean, really, that is the ultimate what has been set up by culture. So imagine for all the brown girls and the girls with, you know, wild hair and different color skin. And I mean, even the white girl cannot handle it, right? I mean, the poor white girl with the prototypical features, she's actually the most in the trap because imagine the standard she has to live up to, right? And I say this about, you know, when we talk about the patriarchy, I talk about the men who suffer under the patriarchy. So when we talk about the ideal white woman, no one really thinks about her and how she must be feeling, right? Poor girl. Like, what a standard, right? Or pretty girls know this, right? What a pressure they have to live up to. Now we're all suffering is what I'm trying to say. Because the messaging is created to pit woman against each other and to pit woman against herself. This is how those in power stay in power. When we love each other and we don't love ourselves.

[Tamsen Fadal]

You know, I worked in TV news and women were all pitted against each other. And the norm was. I was told this, you need to be more like the girl next door.

[Dr. Shefali Tsabary]

Yeah.

[Tamsen Fadal]

And I'm like, yeah, what is that? That's the last thing I look, you know what? And it was skinny and it was, you know, straight hair. And they wanted me to get rid of my name because they said it was too ethnic. And so I lived that. And I still think about it. I write my name down and I still. It's still. The thing is still running back there. And so I can imagine, imagine, you know, it's just gotten louder and louder and louder in time. I want to go back to talking about mothers and daughters because I think that there's a lot there. You know, I lost my mom at an early age, but I watch a lot with young women and I think that a lot of who I am was shaped by who she was. Obviously. I feel like a lot of these relationships carry on as we're adults. What do we carry with us? We carry body image with us. We carry insecurities. Do we carry jealousy? Do we carry all that with us? Even if our, you know, my mom, I haven't had my mom in my life for years. Do we still carry that into adulthood?

[Dr. Shefali Tsabary]

Yes. And it's so subtle, almost imperceptible how we pick up on our mother's cues. You know, when I gave birth to a daughter, I was like, oh, my goodness, the burden is even more now because the mirror is so much More, you know, identical. You know, when a son looks at the mother, there's an immediate separation, like, okay, I don't understand you, you don't understand me. We know we don't understand each other. That's like some healthy space. But when you have a daughter, the enmeshment potential is even greater, right? And she's seeing herself through how the mother is seeing herself. So how the mother eats with gusto or turns her face to the sun and smiles, how she shrinks in a crowd, how she speaks up at a table, how she. She, you know, wobbles around the house in her pajamas, all of it is imperceptible, but being profoundly of influence to your daughter's psyche, it's a pressure. But I don't mean to be an alarmist, just so that we can become conscious that the greatest gift we can give our daughters is our self love and self acceptance. Not to say I'm beautiful, but to say, you know what? And I'm an actor. Yeah, you know, all of it. And to accept it. When I had to make the choice to. To divorce, I thought about, you know, how much easier it would be to stay and allow her to have that stability. But what was on the table was not just stability. It was the price of my inauthenticity.

[Tamsen Fadal]

And she would have seen that.

[Dr. Shefali Tsabary]

And I was like, which one? Which one now do I give stability? And they keep it in the box, keep it so clean, keep it so comfortable, so easy, but do I give up my authenticity? And it was so hard. It is still hard. And I could still cry at the torture of the choice. But here's the thing. The fact that we have to make a choice, that is the treason. That marriage has been set up as a choice of either this or there's shame and there's instability, and she will have to suffer. Cultures, precisely projections on what culture decides is a failure. This is a setup. Marriage is a setup. It's a cultural setup, too. And the woman feels trapped, and the man, too, in this exclusive lifelong bond that if it breaks, is an indication of your value and worth. Again, just like the body has been touted as an indication of your value and worth, just like your job, just like your beauty. This is a lie. And until we uncover the value and worth from external factors, we will stay in the cage. And that work to uncouple is an individual radical awakening.

[Tamsen Fadal]

I mean, it's not sexy, it's not.

[Dr. Shefali Tsabary]

Fancy, and it's messy. It causes a lot of isolation because you're going against the tide. But when you do begin to liberate yourself and you actually walk in your truth, that is your gift. That is the legacy you want to have left behind of a trail of authentic choices.

[Tamsen Fadal]

Well, and it's also, I think, what people see right when you walk into a room and there's some beauty and confidence and feeling of power, that's what they see. They might not even know what it is exactly.

[Dr. Shefali Tsabary]

It's that inner strength of somebody who's comfortable in their own skin and isn't here to be a competitor who wants to lift other women up, who. Whose worth comes from the sisterhood. And that's what we need to reclaim each one of us.

[Tamsen Fadal]

What do you think is the most important thing that we can do to help, especially daughters? You know, we've talked about body image. We talk about being authentic. We talk about, you know, the. The outer appearance that young women constantly. I mean, I'm sorry, it's just. It doesn't matter what we say. Even if we say we're aging or we're pro aging or we're not anti aging, whatever it is, we're all aware of what's going on. How do we. How do we start to change this mess so that, I don't know, our daughters and our daughters aren't only teaching us that we can also continue to teach them.

[Dr. Shefali Tsabary]

Yeah, I'm gonna show you what this. Because this is what we need to teach them. The lies that we've been told. I'm just gonna show you so. The lies about love, the lies about marriage and divorce, the lies about our sexuality, the lies about motherhood, the lies about beauty and youth, the lies about niceness. We as women need to tell our daughters how we've been lied to. And they cannot fall under the trap and the h. Hypnosis of what culture has ensnared our generation with. So when a woman liberates herself and sees through the bullshit of the Matrix, she liberates other women. She liberates. And that's why I wrote this book. Even though I was outing myself right here. I was going through a divorce. I was a clinical psychologist. What? I couldn't even keep my marriage for another 25 years. I only did 20 resoundingly. But I knew that that was a lie. I know. I know my lies. I know all the lies that my ego tells me, so I'm able to talk back to it and tell it to hold and keep marching on. And had I not. And had I been gullible to the influence and the Power of cultural projection onto me, I would have cowered and never written a book. But upon writing this book, you know, when I see it in people's houses, I ask the husbands, how you doing? You know, like, because this is a fire starter, right? This is an ignition. And if the woman is discontented, disconnected from her truth, this book is going to reclaim that for her and create a ripple effect. But here's the beauty. When one woman speaks her truth, and you know this so well, because you do this, it liberates the men in her life. It liberates the children in her life, it gives everyone permission to fade. Because the failure is the greatest alchemy possible. Into your next self, right? If you don't die, there has to be a death. So you could call it failure, you could call it divorce, whatever that is. There has to be a disintegration for your next self. And what a tragedy if all your life you're just one self. Like, what a. You have to.

[Tamsen Fadal]

How boring.

[Dr. Shefali Tsabary]

How boring. We owe it to ourselves as we live longer, right. Back then we were dying by 55, so we lived.

[Tamsen Fadal]

Yeah, we have two lives now.

[Dr. Shefali Tsabary]

Now we have to have different versions of ourselves showing up with different chapters and different eras and different people. And we never had access to longevity. We never had access to travel, global travel, or meeting strangers from all across the world. So we must grow and allow that shedding of the old skin. But we're terrified of what people know is terrifying. But what are we really terrified of? Of what people would. That's it. And here's where we give our power away to what we think they must think about us. Because we really never know what anyone's thinking about us anyway, Right.

[Tamsen Fadal]

It's funny, I had a therapist one time when I was young and I was battling an eating disorder, you know, I was in my 20s. And he said, you're looking, you're talking to somebody and you're painting their canvas of what you think they think of you. And it was such a mind, you know, I'm like, wait, what? But I never forgot that analogy because. And I, I thought like, oh my gosh, every time, we do that all the time, right? How my body looked, how nice I was, how successful I was.

[Dr. Shefali Tsabary]

Yeah. And it's actually, even though it appears that we care about what other people think, it's actually the ultimate self absorption because we so care about what they care about, what we think. So we are the focus of what we care about. So that is highly self centered and that deep attachment to what are people saying about me? What do people feel about me? Am I pretty? Am I good? Am I smart? This focus on the I is the disease of this modern Western imperialist culture. The I, the ego. You know, in Eastern spirituality, in Buddhism in particular, you understand that the I is the greatest illusion. The I, the eyes. The eyes, right? My daughter, my, my, and I are the greatest tribe and the disease of the human mind. And this is where we're heading, right? We're becoming more my and I. You know, we're living in nuclear families. We are talking about our children. We care about our social media account now. We care about our faces on them. I mean, it's a mass obsession with something that is designed to disconnect you, right? The obsessive focus with one's own ego is the disease of the world, if you ask me. Give a diagnosis. I will say we have become insanely delusional, deranged, obsessed with our own ego, and this is the illness of society. So, you know, once you understand this.

[Tamsen Fadal]

You can shed that and look at it differently. Or do you have to do. How do you unlearn it? How do you unlearn something like that.

[Dr. Shefali Tsabary]

When you realize that the I, this ego that you're so chafing that you think is something, is permanent? It's a thing. It's not a thing. It doesn't exist. Like, whatever you're chasing, I am the CEO, I am the author, I am the podcaster. It in itself is in your own mind only because you don't know what that means for anyone else. So you're projecting it like your therapist told you all the time. So you're playing a game within your own mirage in your own internal psyche, and you can eat yourself alive manipulating that image of yourself in the world when it really doesn't even matter, right? So when I leave here, I may think, oh, my God, I hope, Hope you know, they like me. Did I say something? Did I? I, I, I times and times.

[Tamsen Fadal]

Did she?

[Dr. Shefali Tsabary]

Did she? Did I? Did I? You won't even give it. I know, because when people. When I. When you leave me, I'm not gonna be thinking about you. I'm sorry. I will love you. I will hold you. But I'm moving on, and so does everyone else. But we are attached to the image.

[Tamsen Fadal]

Gosh, you're so right.

[Dr. Shefali Tsabary]

It's our own attachment.

[Tamsen Fadal]

How do you teach kids that? You know, you. You reference, like, what's real, what's not real. How do you start to show adults have a hard enough time with that.

[Dr. Shefali Tsabary]

I think because we have become so, so fragile and we're so, so positive. Psychologizing everything. Our children can grow up with a mistaken obsession with their preciousness.

[Dr. Mindy Goldman]

Okay.

[Dr. Shefali Tsabary]

You know, like I'm precious, I'm special. And we need to break that.

[Tamsen Fadal]

It's different than confidence.

[Dr. Shefali Tsabary]

Oh yeah. This is about this attachment to the ego I'm talking about. Right. How do we help our children not have this obsessive attachment to their image of who they need to be in the world? It comes from us parents. Like I tell parents all the time that, please teach your children that, yeah, they're unique, but they're not special, you know, and that message needs to come through in when our kid comes to us. Mom, I got a D grade. Oh my God, I got a D grade. Okay, so maybe your mind for that is D grade mind. It's okay, like you don't have to be a grade. You see, it seems counterintuitive. It feels like I'm shaming, but it's not. It's this focus on, you need to get an A. This is narcissistic. You're so special. You need to be a well rounded person. Maybe you're not talented, you know, and that's okay. This idea that we are constructing children who need to be these amazing rounded people is pressure on them. It's unrealistic and it creates only anxiety and breeds this fragility that I need to be special. So if I'm not special, I am nothing, then what am I?

[Tamsen Fadal]

Yeah, it's all or none.

[Dr. Shefali Tsabary]

Yeah. So I teach parents, your child is ordinary at best. They may have a spiked talent here and there. I mean, poor kid. If they are talented, because then, you know, that parent is sending them to Juilliard, sending them to Hollywood, signing them up for like better the ordinary kid, they can just be under the radar of the parent's projection and live a well rounded life. But try to focus on your kid's ordinariness and find worth in that. But ordinariness, average. These are dirty words for parents, right? They're like, my kid is average.

[Tamsen Fadal]

My kids are. Yeah, I get that.

[Dr. Shefali Tsabary]

I mean, I didn't have a kid to have an average kid. I had a kid to be, you know, a superstar. See, the parents ego, of course, but when you do have so much ego, you actually create fragility. Because now your sense of self is dependent on that image out in the world.

[Tamsen Fadal]

And when that image is gone or.

[Dr. Shefali Tsabary]

When it comes to the goal. Yeah. So when the CEO loses his job. When the stockbroker, you know, and the market crashes, when the woman puts on weight or when she, she becomes older, she now goes through an existential crisis and in order to buffer her from that, she needs to develop an inner worth.

[Tamsen Fadal]

Do you think it's hard for women because our bodies, this is where our bodies have changed now. So especially Gen X women who went from I've got to be this perfect and maybe I worked really hard in these in between years to now I have belly fat or my arm looks different or my, you know, and they're fighting it just like we've talked about. Do you think that that's what we're seeing here? How do you say to a woman that's in midlife or in menopause and their body is changing, you've got to start accepting those kind of changes and work at it at the same time so you feel good about yourself.

[Dr. Shefali Tsabary]

We're not accepting our changes and we're not working at it. We are trying to reverse it. We are. I mean, not you.

[Tamsen Fadal]

It's hard.

[Dr. Shefali Tsabary]

Not you.

[Tamsen Fadal]

I'm talking about. It's hard. You are. No, I understand. I understand.

[Dr. Shefali Tsabary]

And we see it in Hollywood, we see it in media, you know, plastics, I. And of course you press one post and you get a burst of algorithms that come at you. But just because the technology has allowed us now to fix and tweak and that's fun, go ahead, do it. You know, we've been dyeing our hair forever. That's technology. So we've been on the pill forever. That's technology. So as technology advances and our ease with which we can reverse some signs of unpleasant aging that we don't like, go for it. But we need to understand that if we obsess about this and if we believe that we are lesser than, then we are, you know, just sabotaging our own highest potential. Because the main growth and the main gift of growing older, right our age now when I, you know, for me, my child is older, I'm no longer the parent, the mother, the Reverend Mother is the gift of this age is not to cling to youth. The gift of is to finally release the need for others approval. Like finally, you know, I don't need a man or a lover or my mother, I don't need. And when we don't give ourselves that gift, and it takes work to walk through the threshold to your own liberation, but we actually spiral back into trying to be the 20 year old who you can never be now you're literally sabotaging what this era in your life is supposed to be about. Now, of course, I look in the mirror and I go, oh my God. Every day I see changes. Yes. Compared to just five years ago.

[Tamsen Fadal]

I know, Me too. I found crepey skin all over my. I was like this, I went into my husband, I'm like, is my skin crepey?

[Dr. Shefali Tsabary]

He's like, I'm not answering.

[Tamsen Fadal]

I'm not in this conversation.

[Dr. Shefali Tsabary]

Right.

[Tamsen Fadal]

But I know what you mean. I'm different than, than I was two years ago.

[Dr. Shefali Tsabary]

Right. So we have to now understand that age is accelerating by the moment and find our connection to ourselves through other ways. You know, my grandmother never used to look in the mirror. Okay. Now she came from an Indian heritage in an era that was very self sacrificing and she didn't have to be so extreme about it, but she would literally never look in the mirror. But what she told me will always stay with me. She said, you know what freedom it is that I just don't look at the mirror? It's like not having the weighing scale. Right. But not having a mirror. So she would look down, she'd have a mirror, she'd check at the end, but she'd put her whole saree and her bun and look down. She said, because I don't want to focus on this anymore. And I was like, what? Like my entire, at least half of my image is based on what I see. What a freedom she gave herself.

[Tamsen Fadal]

Yes, she did.

[Dr. Shefali Tsabary]

So imagine just like you don't buy the weighing scale, just like you don't shame yourself after digging into the chocolate cake, maybe you don't look at yourself that much.

[Tamsen Fadal]

Yeah, right.

[Dr. Shefali Tsabary]

And do yourself a favor.

[Tamsen Fadal]

I love that. When did she stop doing that? When did she stop looking in the mirror?

[Dr. Shefali Tsabary]

Like in the last 10, 12 years of her life. Like a long time. She just let it go and there was a little bit of self sacrifice there and a martyrdom. You know, Indian, you know, that generation had to have some. Yeah, like I'm a martyr now. I'm older, I don't deserve to look pretty. All that bullshit was done.

[Tamsen Fadal]

Do we martyr now? Do we do that?

[Dr. Shefali Tsabary]

We martyr. But I don't see my daughter's generation martyring. In fact, I wish there were like some martyrdom, like something give up something for your comfort. Can you like sacrifice something? But they refuse to. And I think again we have, I mean, to take credit, maybe it's not due, but I think we've paved the way for them. And no one paved the way. You Know, I think Gen X is a defining generation.

[Tamsen Fadal]

I like that conversation though, because I don't think we've actually looked into that. You know, I don't think we talk about that part enough because I think it all kind of moved very quickly. And then there was this difference of generations.

[Dr. Shefali Tsabary]

I've been studying this so much.

[Tamsen Fadal]

Yeah.

[Dr. Shefali Tsabary]

Because I see it in my practice. And a 35 year old is, I'm talking to a different animal, to a 28 year old. Like the eras are changing so fast and what was fed to the mind of a 35 year old is already different to 10 years younger.

[Tamsen Fadal]

You know, I'll be curious to see what they're like when they're older. So like, I think, you know, I was a, I was tried out for like a cheerleading team when I was young. I was on it. Not young, college. I was on it. We had to have weigh ins in order to be able to perform on the field. That was very normal. My mother never said, you can't do that with my daughter. It was, it was a norm thing. I can't even imagine if you said that today. But does that still happen today?

[Dr. Shefali Tsabary]

I don't know whether it happens. I don't think it does in the same way. But the looks and the sneers are the same. Should I give you one of the biggest truth bombs?

[Tamsen Fadal]

Yeah.

[Dr. Shefali Tsabary]

This whole setup that the woman is under scrutiny, the woman is under attack. The woman's body, the woman's face, the woman's age, all of this is creating by modern toxic patriarchy. What I mean by that is we as a female species were the choosers. We are meant to be the choosers, not the chosen.

[Tamsen Fadal]

In the relationships.

[Dr. Shefali Tsabary]

In anything in the relationship. Because if you look at it biologically, our egg is waiting and the sperm, billions of them, cheap and dying fast, have to swim to. If you look at it as a metaphor, we have the golden egg. We only have around 400. We have to use them wisely. We have to choose who gets to penetrate. We have to select with discernment. Every female animal knows this. We did too. What modern toxic patriarchy did is made us be chosen. What that does is that we began competing with each other. We had to be the peacock. See, in the animal kingdom, it's the peac. It's the deer with the big antlers. They know. It's the silverback gorilla. They know who's the alpha and how to compete. The males do it, the females select. If you look at the puffer, the puffer fish, the mannequin they all have to fight for the attention of the female. But look, what an amazing reversal. Modern, toxic patriarchy took us off our crown and said, oh, you're gonna choose? No, no, no, no, no, no. We are gonna choose. So you walk into a party today, the men are fat and balding. They haven't even combed their hair. No. Don't you sometimes look at your partner and go, no, you are not leaving the house like that?

[Tamsen Fadal]

Yeah, of course.

[Dr. Shefali Tsabary]

And they're like, of course we, you know, they don't put no face cream. They don't have a chemist shop in the bathroom. They have one, maybe a hairbrush. Why is that? It's not because they're more confident. I don't know. It's not because they're more confident. It's because we fell into the trap and the trap was laid for us. And now we willingly participate. We mutilate our bodies, we go on crash diets, we torment ourselves in our body. We take 24 hours, you know, to get ready for the next big event. We start dieting. Six months. All of this is our own inner persecution now. But of course, the trap was laid out and we were told this is the way to be so that we lose our power.

[Tamsen Fadal]

Do you think we're starting to reverse that?

[Dr. Shefali Tsabary]

I hope so. But the main way to reverse it is when women enter a sisterhood. We have to stop competing with each other. So the more you and I show up, you know, messy, you know, ourselves, humble, of course. We don't have to be like how men show up, you know, God forbid, but more natural, more ourselves, bearing ourselves with vulnerability. When you talk about how you're losing your mind, that is how we allow our sisters to know we are safe. The enemy is not here. Right? And when we rise in sisterhood, in sorority, that is how the power changes. It doesn't change when men give up their power to us. Why would they ever do that?

[Tamsen Fadal]

No.

[Dr. Shefali Tsabary]

And it's not about them giving up something because we don't want somebody to sacrifice anything for the other. We have to rise. And we're doing it more and more. We're seeing it more and more, you know, with the Epstein files or with the MeToo movement. But we women have to create the same space to stop competing with each other and stop outdoing each other and out beautifying each other and stop laying ourselves at the threshold of male attention and male energy. We have to take it back. We have to say, oh, you like 20 year old women or you like you Know your secretary. The road is paved with gold.

[Tamsen Fadal]

Feel free.

[Dr. Mindy Goldman]

Right.

[Dr. Shefali Tsabary]

I am. Good. But instead, what we do is we mutilate ourselves to become the secretary, right?

[Dr. Mindy Goldman]

Yeah.

[Tamsen Fadal]

If there's one message you would want women to hear leaving this, what would it be right now? I mean, there's a lot out there to take in. There's a lot of things that we sit and talk about. Mutilating ourselves and changing our bodies and trying to be perfect. If there's something you wanted women or parents to hear, what would it be?

[Dr. Shefali Tsabary]

It's just understand that you are masquerading as your true self, and you need to. And let go of the show, of the Persona, of the way you present and stop being defined by that presentation, because it's an illusion. And when you wisely enter that awareness, you discover that your greatest relationship is the one you have with yourself.

[Tamsen Fadal]

Dr. Shefali, I'm so happy you came. I really am. A radical awakening. This is. This book is extremely, extremely special. If you do not have it, go get this and make sure it is on your bookshelf and on your night table. And you're reading it. And where can people find you?

[Dr. Shefali Tsabary]

Well, I think my Instagram is. Yeah, I have a podcast. It's called Parenting and you'd. And it's about the inner work of the parents. So parents come with their uncensored issues and it's unedited, and I help them in real time. So it's great to tune in and just see how I deconstruct everyone's problems. They come from teenage. They bring teenage issues, bulimia, body issues, spousal conflicts, and we deconstruct it in real time on the pod. And then I have a coaching institute. I coach people to do what I do. They can find me on Instagram, rshafali and all, you know, regularly.

[Tamsen Fadal]

And you're coming back, right?

[Dr. Shefali Tsabary]

I'm coming back.

[Tamsen Fadal]

Thank you so much. Thank you, Dr. Mindy. Menopause can bring so many surprises. From your experience, what are some of the changes that women often overlook, especially ones that can mimic or make mask early signs of breast cancer?

[Dr. Mindy Goldman]

That is such a great question because I think that many people know of the classic menopausal symptoms like hot flashes and night sweats and sleep difficulties and mood changes. But there are so many other menopausal symptoms that people may not be aware of, and they either overlook them or they seek out support from specialists. Things like hair thinning, hair loss, dry mouth, constipation, palpitations, joint pain. So Many, many symptoms of menopause. I think that the perimenopause, which is the months or years preceding menopause, is often that time period where people start experiencing those symptoms and they worry, what's wrong with me? And when it comes to breast health, I think what happens is a lot of people start experiencing all of these hormonal symptoms, and they may ignore some of their screening. So they may forget, oh, I am due to get a mammogram, or I have a family history of breast cancer, I need to be followed more closely. But they're so focused on what's going wrong with me that they ignore and they don't get their record recommended screening. So I think those two things overlap a lot because people miss out on getting the screening that they need.

[Tamsen Fadal]

So are there particular windows during perimenopause or menopause when women should be especially vigilant about breast health?

[Dr. Mindy Goldman]

Yeah, well, one of the things we know is that the incidence of breast cancer really starts going up around age 50, and that's the same time average age of menopause is 51 and a half, and the age the US and so the same time that women are experiencing all of these hormonal shifts and hormonal changes are the same time that we start seeing breast cancer rates go up. The other thing is, if you look at the indications for screening, almost all the large organizations recommend beginning screening at 40, but there's a lot of individualization in terms of how often to screen in the 40 40s. But every organization agrees the benefits of screening are there starting at age 50. So women need to be coming in, they need to be getting their exams, their regular screening, and it's the exact same time that they're going through all of these hormonal changes.

[Tamsen Fadal]

So how do you guide women in making safe, informed choices around hormone therapy? Because I know that is continuing to be a big question. I know we just have about 5% of the US taking hormone therapy, but there are a lot of women that want to know if they can.

[Dr. Mindy Goldman]

I love that you point out that statistic, because it is crazy that only 5% of US women are taking hormones. And I think the reason that number is so low is still the fallout that we're getting from that large women's health initiative that was published now 25 years ago and really scared women and made them think that hormones caused breast cancer. We know a lot of more about hormones since then. We know that hormones do not cause breast cancer. We know that that study used a specific formulation and showed a higher risk of breast cancer with one specific formulation of hormones. But the fallout from that has persisted to today. So most women think hormones are dangerous. I should just avoid them and suffer with the symptoms. And unfortunately, in the medical community, community, anyone who is also trained, since the women's health initiative, thinks that too. And so they're giving the same message to women, which is just deal with the symptoms, they'll get better with time. Women are wanting more. They do not want to be told the same thing anymore. And that message is finally changing. And we are very proud at miti to be having these conversations with women and giving them the appropriate evidence. And it turns out, it turns out that for the vast majority of women, hormones are not only the most effective treatment for alleviating menopausal symptoms, they are safe, and they are started at the appropriate time. Soon after menopause. They can decrease the risk of heart disease, which is the number one cause of death, Decrease bone loss, and have cognitive benefits as well.

[Tamsen Fadal]

That's the message, to constantly get out and talk about the other things. Aside from just working on hot flashes. You know, you have worked with many cancer survivors and high risk women. How is menopause different for them? And then what kind of care do they need? That gets oftentimes overlooked For a lot.

[Dr. Mindy Goldman]

Of cancer survivors, they get the message of be thankful you're alive and just deal with the side effects of treatment. And we know that that's not true. No one should have to suffer. And cancer survivors oftentimes experience earlier menopause. So, for example, with breast cancer, sometimes people will be recommended to have their ovaries out as part of their breast cancer treatment. Also, many breast cancer patients get put on ovarian suppression drugs, so drugs to quiet the ovaries so that they can then take certain types of hormonal medications, what are called aromatase inhibitors. Those drugs are used as a breast cancer treatment, but they require someone to be menopausal. Other times. Some of the drugs that we use to treat breast cancer, like tamoxifen, can cause a lot of side effects, like hot flashes. So for a whole host of these reasons, cancer survivors end up experiencing more severe menopausal symptoms and sometimes end up up going through menopause early. The other big thing we see is for cancer survivors who get chemotherapy. Chemotherapy affects rapidly dividing cells, which is why it's effective for cancer treatment. But it also affects the follicles in the ovary, and it can put people into menopause. And whether it's permanent or not depends on the age of the patient and how much. So if you get chemo when you're 40 or more, chances are you're going to have permanent menopause.

[Tamsen Fadal]

Well, you know, a lot of women in midlife say they feel dismissed, they feel invisible, especially when they bring up symptoms. Can we talk about how MIDI Health is helping ensure women are heard and also supported?

[Dr. Mindy Goldman]

It's amazing that women are saying that they do feel dismissed and not heard in every part of this country. One of the things that's been so surprising as we launched committee is we are now in every state, we are in rural areas, urban areas and women are being told the same thing. Again. I think some of the reason why they are is the fallout from the Women's Health initiative. But they are being told, just deal with the symptoms, they won't last that long, they'll get better with time. Hormones are dangerous, don't use. And at miti, we are trying to change that conversation so we have evidence based protocols that guide our care and we have care providers all over this country providing care to women in every state within this country, insurance covered care. Because if you want to change this conversation, you need to make sure you're reaching people by offering insurance covered care. And we are doing that in every state. We hire people, people who are experienced in women's health and then on top of that, they get very extensive training into our many protocols. We cover both classic areas of women's health. Certainly the core competency is perimenopause and menopause. But we also know women have excess problems to primary care. And so we have protocols to help people with their bone health, with lipid management, with their mental health, with their sleep, with their brain fog, whole host of symptoms. And then we have ongoing support to ensure that our providers are kept up to date with the latest information that they can then share with their patients. And I think educating women throughout this country, letting them know that, do not let someone tell you that you just need to suffer at this time time getting that information out. I love what you do on your podcast that you get this information out there to people everywhere. It's so, so important. And at MITI, we're trying to help.

[Tamsen Fadal]

Thank you so much, Dr. Mindy. You know, you know, you address some of the big gaps in menopause care and breast cancer awareness. How is MITI working to close those gaps?

[Dr. Mindy Goldman]

Some of the gaps in menopause care are a little bit different than what we see with breast cancer. So, so with menopause care I think the biggest gaps are in educating people about what are the benefits and what are the risks of hormone therapy. So at miti we are trying to educate our patients who come see us by giving them evidence based information. I think one of our special sauce, if you would, is that we also know that medicine is changing all the time. So not only are, not only is the information we give people consistent with large guiding organizations like the Menopause Society and the American College of Ob gyn, but we take new information, evolving information and incorporate that into our discussions with our patients. So one way we are addressing that is by our direct one on one with our patient visits. We also realize that none of our patients see us in a vaccine vacuum and they all have other healthcare providers. So we also partner with health institutions where 20% of our patients need in person care. So we send our patients back into those institutions and we provide lots of education for the people that are there. We do webinars, we have these detailed care plans, we provide letters to other physicians to support the treatments that we are providing, providing. We also do it on the employer side. So MITI is now a health benefit for many large employers and we provide webinars for employees of these large places like Pepsi and Oracle, big companies. And so we are doing the best that we can by educating people throughout this country. We are also trying to expand access by expanding our insurance coverage. So every day we are trying to expand our insurance coverage across this country. Because until you can provide this care for insurance covered care for women everywhere, I don't think we will make a big enough impact on the breast side. I think there's a lot of misconceptions about breast screening. A lot of people think mammograms are going to expose me to radiation. That's dangerous. I shouldn't be getting testing. If I compress my breast breasts, it will spread a breast cancer that's already there. That is not true. And we need to do a better job of educating people. There's certainly disparities. There are a lot of communities across this country that don't get access to appropriate breast health education. People need to know what's called breast self awareness. The old days of doing self breast exams are gone, but everyone should be aware of what their normal breast tissue feels like. And if you feel something differently, you need to know. I need to go into my provider and get that checked out. So education and awareness and making sure we are reaching people throughout this country I think is so important.

[Tamsen Fadal]

I love the fact that you all do it360 because there's so many different areas we need to hit right now to reach women and reach providers for women who want to take charge of their health in their 40s and 50s. Because I think that is that time where we, we say this is what you need to do. What steps do you recommend to stay proactive when it comes to menopause and also breast health?

[Dr. Mindy Goldman]

So one of the things is making sure that you educate yourself and you understand what are the symptoms of perimenopause. We have found at MITI that the average age of patient that we are seeing is dropping. And it's dropping because I mentioned before the perimenopause is oftentimes a more confusing period of time than menopause because people start experiencing all of these weird symptoms like dry mouth and palpitation and hair thinning and weight gain and they're wondering what's wrong with me. So one thing I would say is if people start feeling different than their usual selves, think that this could be perimenopause, menopause. And don't accept someone who tells you, oh, it's just a normal part of aging. Seek out expert care, come see us at MITI or see your own providers, but don't accept the standard. So that's one thing I think when it comes to breast health, people need to realize we are seeing more breast cancer in younger women. Even though the time period when we commonly see breast cancer being diagnosed is in the field 50s. The rates of breast cancer are increasing and have been increasing in women under 50. People need to know their risks. A lot of women don't understand their risks. If you have a family history, particularly in a first degree relative, a mom or a sister, that increases your risk and you need to have closer follow up. That may mean you need more frequent breast exams. You may need earlier imaging and different types of imaging, things like MRIs are done for people who are high risk. So understand what the risks are. Family history is one of the biggest one, some families have genetic mutations and knowing those risks, making sure you're getting the appropriate screening. The other thing I like to point out is that people don't realize that there are of lots lifestyle things that can increase risk and that they can do to protect against breast cancer. So we have evidence that regular exercise, specifically interval cardio, 150 minutes a week divided times, decreases risk of breast cancer, colon cancer, liver cancers and others. And if you've had breast cancer, doing that amount of exercise can decrease risk of recurrence. For hormone positive breast cancer and improve survival survival Minimizing alcohol. Alcohol is a risk factor for hormone positive breast cancer. So if you have a strong family history, maintaining normal body weight, exercising and minimizing alcohol will be important. So understanding your own personal risks. If you ever feel something, something seems different. Making sure you're seeking out help.

[Tamsen Fadal]

If you could leave our listeners with one key takeaway about menopause, breast cancer health and owning their own midlife narrative, what would that be?

[Dr. Mindy Goldman]

Don't accept that if you have a family history of breast cancer that you need to suffer through perimenopause and menopause. We do not have any good evidence that says women who have family history of breast cancer cannot take hormones. That doesn't mean hormones are for everyone. Most breast cancer survivors we talk to about alternatives to hormones, hormones, but do not accept what people have been saying for years. Do not accept that you have to suffer. Whether you are a healthy perimenopause menopause patient, whether you are a person who has gone through, is going through or has gone through breast cancer treatment, you do not have to suffer. We have effective treatments for virtually any symptom that people are experiencing during midlife.

[Tamsen Fadal]

I'm so glad you said that. You know, as someone who lost a mother to breast cancer and lived with that cloud for such a long time and realized that I had options and solutions and hormone therapy is one for me, I just think that, you know, it's not for everybody, but there are other solutions out there. So I for one, you know, it really has been a personal experience for me. Dr. Mindy, thank you so much.

[Dr. Mindy Goldman]

Thank you so much for having me here and really excited to talk about these things because it's so important.

[Tamsen Fadal]

It so is. Thank you for your time. Hey everybody. I want you to know today's episode was sponsored by MIDI Health. If you're ready to feel your best and write that second act script, visit joinmitty.com today to book your personalized insurance covered virtual visit. That's joinmitty.com MIDI the care that women deserve. Welcome to Decoding Women's Health. I'm Dr. Elizabeth Poynter, Chair of Women's health and Gynecology at the Atria Health Institute in New York City. I'll be talking to top researchers and clinicians and bringing vital information about midlife women's health directly to you.

[Dr. Mindy Goldman]

100% of women go through menopause. Even if it's natural, why should we suffer through it?

[Tamsen Fadal]

Listen to Decoding Women's Health with Dr. Elizabeth Poynter, wherever you get your podcasts.