“Did you see the news about Naomi Osaka?”

My texts pinged nonstop last week, but I was doing my best to ignore them. I was deep in my writing cave, determined to tune out the world so I could deliver the first segment of my upcoming book to my publisher on deadline: a chapter on saying no as the backbone of real self-care.

I’m a psychiatrist who specializes in women’s mental health. I’ve been writing about how saying no is real self-care for years. So only after I emerged back into the world (and, by world, I mean Internet) did I understand why my friends were blowing up my phone.

When it comes to boundaries, you always have a choice

Naomi Osaka is a 23-year-old Black woman (Osaka is half Japanese and half Haitian, and grew up in the United States), an international tennis champion, and the highest-earning female athlete in the world. After winning the 2018 US Open against Serena Williams, and being booed by the crowd, she’s spoken openly about her struggle with depression and social anxiety. She’s no stranger to making unpopular decisions and standing up for human rights, like when she elected to skip play in solidarity with the national protests over George Floyd’s murder last year or when she brought seven masks to the 2020 US Open, each highlighting the name of a Black victim of racial violence and police brutality.

In our society, as a woman, you cannot say no without paying a price.

Last week, Osaka prioritized her mental health and told the French Open that she would not do press during this year’s tournament. Since her 2018 win, she has struggled with public speaking and, in her statement, noted that setting this boundary was an act of self-care. Unfortunately, press is part of her contractual obligations for the event, and the French Open responded by fining her, which led Osaka to make the difficult decision to drop out of the tournament.

All the women I take care of are weighing the costs of prioritizing their own mental

When I’m working with my patients, I remind them that when it comes to boundaries, you always have a choice: You can say yes, you can say no, or you can negotiate. Undoubtedly, my patients say, “Yeah, but, the cost of saying no is way too high. I can’t deal with the guilt and the backlash.”

In our society, as a woman, you cannot say no without paying a price. Especially if you are a woman of color. Especially if you’re a young woman. Especially if people are making money off of you.

I see every day how hard it is to make these calls.

I am not a Black woman, so I cannot know or fully understand that experience. Stella L. Hargett, an associate professor of sociology at Morgan State University, and co-editor of a 2018 study commissioned by The Undefeated, which analyzed the impact of stigma, stereotypes, and racism on media representations of Black professional female athletes, has said, “If you’re going to talk about respect [of Black female athletes], that respect is always going to be conditional.” For Osaka, the costs now include being propped up as a symbol for mental health, which only adds to the heavy burden she already carries as a young, Black woman and elite athlete.

While I admittedly do not take care of any professional athletes in my practice, all the women I do take care of are constantly weighing the costs of prioritizing their own mental health inside of a social system that aggressively penalizes them for those choices. So I see every day how hard it is to make these calls. The costs, whether they are financial or relational, are damning.

It’s powerful to see someone at Osaka’s level openly “do the math”

To be clear, the solution to our country’s mental health crisis is not up to one individual. Instead, the solution must be systemic, starting with investing in infrastructure: mental health benefits, the care economy, and employee leave policies. Until government and private sector infrastructure are in place, women (and men) will continue to pay a brutal price for simply choosing to take care of their own mental heath (when, and if, they have the luxury of even doing so).

So how does this structural change happen? In part, through a change in culture. And as a psychiatrist, I have to believe that individual choices—especially the decisions of people with high visibility—can ultimately change that culture. Though most women I work with do not have the luxury of stepping away from their income source, it’s powerful to see someone at Osaka’s level openly “do the math” and come out putting her mental health at the top.

Answering that question for myself was to more clearly understand what success looked like for me

I’ve had patients decide to come see me simply because they heard a podcast episode during which a celebrity spoke out about depression. These public choices, while internal and personal to public figures, can create a huge impact for fans. So when Osaka says that she’s taking time away from the game to take care of her mental health, it makes space for women who identify with her in some way to reflect and look for spaces, however small, to reclaim their agency and center their mental health—despite the costs.

Perhaps Osaka’s insight into saying no and self-care speaks so powerfully to me because I lacked it myself at age 23. That toxic mantra, But what will people say?, played on repeat in my mind for nearly the entirety of my 20s. It took me more than a decade, a great deal of psychotherapy, and becoming a psychiatrist myself to figure out what real self-care looked like for me. Part of answering that question for myself was to more clearly understand what success—both personal and professional—looked like for me, and the price I was willing to pay to prioritize my own mental health. Full disclosure: That work is never done; it’s just evolving as I move through seasons of my own life.

The solution must be systemic

There is no easy answer to these questions, and I don’t pretend that prioritizing mental is simple. For Black women, minoritized people, and those without access to the resources and privileges that I had, it’s even more difficult and, in some cases, impossible.

In an interview for Voguelast year Osaka said, “I used to think that everything depended on the game, and now I sort of understand that you have to find balance.”

The reality is we cannot look to Naomi Osaka to fix the way our systems have failed us. That burden is not only unfair to her, it’s also not realistic. But, last week, Osaka showed us what it looks like to make success your own, and I think we’d all benefit from learning from her example, while also cheering her on.

Pooja Lakshmin, M.D., is the founder of Gemma, a digital education platform dedicated to women’s mental health, and is the author of a forthcoming book, Empowered: Free Yourself from the Tyranny of Self-Care and Build True Well-Being, by Penguin Life (2023).

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