CHAPTER 1
Why Should You Listen to Me?
I have a couple of reasons why you should listen to me about life balance:
1. I made a long career about the study of the topic.
2. My life story led me to the topic in the first place.
My educational background and life experiences have influenced my unique view of the world. Both inspired me to write this book. Each experience, whether deliberate or accidental, took me down a path that intersected with another route and moved me in ways I could not have imagined.
In 1979, my new husband Tom and I moved to a one-room cabin in the woods in northern Minnesota. We naïvely jumped into the lifestyle mostly because we thought it would be cheap living, but also because we loved nature and simple living. The cabin was the size of a single-car garage, without plumbing or electricity. Our compact stove and refrigerator were fueled with propane, and for heat, we used a small woodstove. In order to survive the cold and snowy Minnesota winters, we needed a large supply of wood to burn, so we spent many hours in the woods, often on snowshoes, cutting and splitting wood and dragging it back to the cabin. We used lanterns for light and gathered water from a nearby creek.
Of course, in the winter, the creek was frozen over, so we had to break a hole in the ice to scoop out the water we needed. The biggest challenge for me was using an outhouse for our other plumbing needs. Toilet seats become frosted in the winter, so to ease the discomfort, we put strips of carpet on the seat to prevent it from sticking to our skin. I didn't like going to the outhouse when it was dark, and even though I knew black bears hibernated in the winter, I imagined meeting one between the cabin and outhouse. I always took a flashlight with me.
Our lifestyle was very simple. I had a professional job as an occupational therapist in town. I would wake up early, put wood in the stove because it had burned down by then and was getting cold, and drive nine miles to work, where I took a shower and groomed before starting the day.
Tom had a few temporary jobs. When he was not working for others, he would fur-trap, log, and ice-fish. In the other seasons, we grew and harvested our own vegetables, hunted for meat, and lived off the land as much as we could. It was surprising to me that, without TV or other distractions, we were never bored. In any season, our days were always full with simple tasks for survival, and once the chores were done, we would take long hikes or cross-country ski in the woods.
We lived in the cabin for two and a half years. When our first daughter was born, it became clear to us that we wouldn't find the kind of work and careers we were hoping for. There are many stories to tell about this experience. (Maybe that will be my next book.) But suffice to say, I didn't know at the time how it would shape my life and career path. Looking back, the main takeaway was that we both realized how little was needed for happiness. We didn't have many material goods simply because there was no place to put them. Going forward into my life, I always had the confidence that a simple life is just fine, and it shaded the way I looked at overstimulated, overstressed lifestyles.
I am an occupational therapist. This educational background is significant to my final story because of the lens through which occupational therapists view the world. We view people and their quality of life by whether or not they are able to engage in everyday occupations or other activities that bring meaning and satisfaction to their lives. Being able to do what we want to do in life is as powerful as taking medication, eating nutritiously, or exercising. The ability to do is fundamental to dignity, self-worth, and life fulfillment. Of course, when people have barriers that prevent this important doing, such as mental or physical disabilities, then occupational therapists help them find ways to remove those barriers or create other ways to do what they want to do. You will see in this book how doing is one of the foundations for living a balanced life.
After we moved from the cabin to the Twin Cities, I took advantage of the opportunity to go back to school for a graduate degree in public health on a part-time basis while growing our family. Public health stretched my focus from individual health to community or societal health. I began to examine lifestyles and stress and discovered how political, economic, and social structures influenced our choices and affected our health and well-being. At the time I was a mother of three. I was working part time, taking graduate courses, and remaining active in the neighborhood. I was also grieving my mother's unexpected and early death.
I was interested in women's roles and finding out how women were coping with all the demands on their time. How do they find the balance between just the right amount of activities to remain stimulated and interested in their lives and way too much activity, a lifestyle that puts them at risk for illness? Right in the middle of this period, I must have been stressed enough to significantly lower my immune response because, at a healthy age of thirty-three, I got shingles. Apparently a by-product of chicken pox, the virus sits dormant until your immune response is unable to suppress it. Stress suppresses the immune response, and we get sick.
When mixing a public health perspective with an occupational therapy lens, I began to wonder about preventing illness and disability through healthy lifestyles. Lifestyles are the configuration of daily activities that we create for ourselves; the mix of activities chosen may be healthy or not. I had the opportunity to experience two very different lifestyles, both with their own challenges and rewards. The configuration of daily activities I had when living in the cabin consisted of chores for survival. We worked to meet our daily needs. The rewards were immediate, having warm water or adequate heat. The challenges were plenty, such as surviving in the cold and darkness, and it certainly felt stressful at times. The configuration of activities when living in town, raising small children, working, and going to school, consisted of caring for others and trying to squeeze in time for myself without anyone noticing. The rewards were very meaningful but not always immediate. The challenges were constant, and stress was often high.
I thought deeply about how I was living my life and what I was doing from day to day. I wondered if one lifestyle was healthier than another. Is it important to have a balance between activities that meet your own needs and others'? If such a balance of activities would be best, what does that look like?
Fast-forward a few years. I am on the faculty of an occupational therapy program at St. Catherine University in St. Paul, Minnesota. Research with my colleagues, Dr. Virgil Mathoiwetz and Dr. Marcia Finlayson, gave me firsthand exposure to people who were struggling to create satisfactory lifestyles. We ran educational groups for people who had multiple sclerosis and felt that fatigue was one of their most disabling symptoms. They had stories about spending all their energy on things that had to get done, like going to work and doing chores, but at a cost of giving up all other pleasurable activities that gave them joy. When they pushed too hard one day for a special event, they needed two days of complete rest to recover. They started losing friends, and their family members were getting frustrated with them.
In our courses, they learned how to make the most of their limited energy by using it on activities that were most important to them. We also showed them how to build energy by resting at strategic points in their day. We found that, once the participants learned and used the energy-saving strategies, they reported less fatigue and reported a higher quality of life.
One of the women in the group said she had to quit her job because of severe fatigue that made her immobile after a six-hour workday. She wanted to feel like she was contributing to the family, so she tried to keep up the house and mow the lawn, a job that used to belong to her husband. She came to the group feeling defeated and distraught because, after doing one or two projects or mowing the lawn, that would be it for the day. Our group taught her to plan her activities to make the most of her limited energy. She decided to mow the lawn in the morning before the heat of the day, as heat also increases fatigue for people who have MS, and to break the one-hour job into two thirty-minute sessions. She cut the front yard one day and the backyard another day. Then after mowing, she would rest before she felt tired and hydrate. We also showed her how to plan for other activities that could be broken down into smaller tasks.
In the end, using a variety of these strategies, she was able to accomplish much more and felt like she was contributing to her family. The success of these interventions reinforced to me that examining our activity patterns and prioritizing activities that are most meaningful to us is extremely important to our well-being. Creating a healthy lifestyle starts with understanding what we do every day and deliberately modifying it to meet our needs.
Then I started reading anything I could that related to life balance and tinkered around with some beginning ideas. I presented some early thoughts at a conference and met Dr. Charles Christiansen, who was also interested in the topic. We collaborated with a comprehensive review of the literature related to life balance.
There was very little on the topic of life balance itself, so we had to piece together information from psychology, sociology, family studies, and occupational science literature on the topic of what constitutes a good life. What we found led us to a first version of a proposed lifestyle balance theory and moved me to take it further by creating a model and measure that I tested in my PhD studies.
The accumulated knowledge I've gained from my education and life experiences, along with the contribution from other scientists' views, are the foundation of this book.
CHAPTER 2
Why Should You Care?
Stress wasn't something that Jennifer worried about. When she married Stan, her life was exactly as she always planned. Her work as a tax lawyer and Stan's career as a graphic designer kept them stimulated and financially secure. Things started to get a little more complicated as their family grew. With three children — ages one, four, and six years old — and both of them working full time, Jennifer began to experience pressure from multiple sources. She worked it out with her boss to start early and leave every day at four o'clock so she could pick up the kids from school and daycare and then take them to their events.
Although that arrangement helped on the family end, she felt like doors closed on the work end. Sarah knew she lost favor with her boss because all the best clients were referred to others who could put in the hours, and she felt awkward and misunderstood by her colleagues when she would leave early as they stayed working.
Stan is also pressured because he has a 10:00 a.m. to 6:00 p.m. work shift that is nonnegotiable at this time. Jennifer comes home exhausted but has to cook dinner every night because of Stan's schedule. Their children have become very fussy eaters, and making a nutritious meal for them generally turns into a frustrating situation, including shouts and tears. Jennifer has gained ten pounds in the last four months and hasn't felt like exercising. Their oldest son is having trouble in first grade, such as hitting others and being disruptive in class. And their four-year-old was recently diagnosed with asthma. It feels like everything is falling apart, and Jennifer is so stressed and tired that she wonders if work, marriage, and family are worth it.
You might be able to relate to Jennifer's story, at least the part about the stress buildup. There are times in life when stress seems to pile on and doesn't let up. Jennifer's life ebbs and flows with stress, but somehow she manages to get through and finds moments when things feel balanced, at least until the next stressful series of events happen. It is not easy to find balance in life, especially in Western cultures where fast-paced living and consumerism set up a perfect context for stressful, lonely, unbalanced lives.
I wanted to understand how to reduce overall stress, but I resisted the idea of examining lifestyles for compliance with a prescribed regimen of activities in order to be healthy. A lifestyle diet with specific hours of sleep, leisure, work, exercise, and relaxation just didn't seem realistic or sustainable. What I found was that most research on life balance agreed that there is no prescription of daily activities that would be considered balanced, like the well-known food pyramid. Generally research points to the importance of considering the outcome of life for each unique individual — such as contentment, happiness, and accomplishment — rather than the specific repertoire of activities that people engage in on a daily basis.
Most scientists agree that one of the most important outcomes of a balanced life is lower stress. That makes sense because, if the way you are living results in good health, happy relationships, and overall contentment, you would probably have lower stress than people dealing with chronic health issues and dysfunctional relationships. You can find excellent books about stress almost anywhere. You can also find reams of research on the physiological consequences of chronic stress on your body.
Stress Can Be Good
It is impossible to eliminate all stress from your life. In fact, according to researchers in positive psychology, it wouldn't be a good idea anyway. Hans Selye, a renowned endocrinologist in the mid-twentieth century examined the physiological stress response and determined there is negative stress (distress) and positive stress (eustress).
Imagine how dull life would be if you never experienced the excitement and happiness associated with positive things, like your marriage, first day of work, travel, or birth of your child(ren). These are actually very stressful situations, but stress in the right circumstances can be considered the spice of life. It can be what creates challenge, suspense, and excitement.
Stress can be a motivator, and that force might explain why we developed a stress response to begin with. Stress helps our brain to focus so we can react to potential dangerous situations in the wild, and this might mean, for instance, trying to escape from a predator. A release of adrenaline speeds up your heart rate and metabolism. In the short run, this results in increased reactions and reflexes, while also acting as a painkiller, meaning you can have better endurance. This level of stress would be a boost for an athlete or help you get through an exhausting public presentation.
I have embraced the idea that the butterflies I feel in my chest before an important speech or meeting will help me do a better job because I'm charged up. Of course, eventually the speech is over, and the stress response subsides. Good stress should be short-lived and not something that exists over a prolonged period. Otherwise it becomes bad stress.
Stress Can Be Bad
Prolonged stress is bad stress and damages almost every cell in your body. The body tries to achieve stability through change, and the physiological response is called "allostasis." Generally the physiological responses are activated to survive the stressor and help us cope. However, if the stress persists over a long period, the accumulated physiological responses builds up. For example, blood pressure responds to the body's need for blood flow given various levels of physical activity. Once you perceive a threat in the environment, your blood pressure also increases to prepare you to manage the threat. This is very useful when you need the blood flow during a race, but it's less useful when your threat is an upcoming exam and you respond by sitting and eating.
Prolonged high blood pressure, when not used for physical activity, will lead to serious health conditions. Similarly the other metabolic, hormonal, neurologic, and immunological responses to stress have protective effects in the short run but accumulate over time if not spent. These accumulated responses make up allostatic load, the wear and tear on the body over time.
Stress Buffers
Since it is impossible to totally eliminate stress, the next best thing is to try to create a lifestyle that at least buffers some of the negative effects. That's not an easy task when you look at the pace of modern life. Lots of things like high credit card debt, urban sprawl, long commutes, and high divorce and obesity rates reflect the lifestyles of Americans that are stressful. Some of the stress we experience is under our control to change; some of it isn't. For example, you can make a deliberate attempt to leave the house earlier to avoid the stress of being late for work. But there isn't much you can do to change the stress of living with a disability or nurturing a family member with a mental illness.
When you are stressed, you can either add to the problem or reduce your stress. Sometimes people think they are coping with stress by engaging in negative behaviors, like smoking, overeating, using drugs or alcohol, or acting hostile or moody. You know which vice belongs to you. And you also know these don't really help. The challenge is to replace those negative actions with activities that will actually help you.
You can do a lot of things to reduce the harmful effects of stress on your body, even if you can't always eliminate the source of the stressor. Generally they are called "stress buffers." In other words, if your life feels out of control with stress and you cannot see how it will get better in the near future, you can do a few things that will reduce the effects on your health. Research supports several attitudes or feelings that buffer stress, like feeling competent or having a sense of purpose, but that isn't always helpful if you can't muster up those attitudes when you need them.
