In a recent editorial called “Life is a Struggle,” I made a point of writing that the editorial was not about “work–life balance.” Well, this editorial is about “work–life balance” and, more specifically, “balancing responsibility and freedom.” Like most of the readers and contributors to Palliative & Supportive Care, I am a busy academic and clinician, trying to juggle a thousand tasks related to various aspects of my work and my personal life. I've been busy doing important tasks related to my clinical and research responsibilities at the hospital, and, as all of us who work in similar settings know, there is almost always more to do than what was on your schedule when you arrived at work. Sometimes even what's on the schedule is truly overwhelming, and you can't imagine you'll survive getting through the day. But we do get through those busy days, and we get through the days where the unexpected crisis has to be dealt with, or the colleague who is out needs to be covered for, etc. That's just “work life!” When you add to the mix all the concerns and responsibilities of our “personal lives,” it can become truly overwhelming, and ultimately some areas go unattended—usually those most important for taking care of ourselves or our loved ones. In our pursuit for “success,” it soon becomes clear that we “cannot succeed at everything, not all of the time!!” And because “time” is limited, we are forced to make “choices,” and we don't always choose well; and our priorities don't always reflect what is truly most important to who we are and what we want to be and become. Our choices are not always congruent with our “authentic selves,” and they don't help us succeed in that quest to “create a life” that is unique to us and in which we fulfill our own full potential. Sometimes our choices are limited by external factors or physical limitations, and so our choices may be more of a choice of “attitude” than a choice of “action.” In work and in life, all of this can lead to what Alain de Botton (Reference De Botton2004) calls “career anxiety” or “life anxiety.” Irv Yalom (Reference Yalom1980) would more likely refer to it as “angst” or the emotional experience of “existential guilt.” These anxieties or feelings of distress often arise from the question, are we “successes” or “failures”? Or, as Donald Trump might classify us, are we “winners” or “losers”?

I've titled this editorial “Balancing Responsibility and Freedom” because I have been thinking a great deal about these two existential concepts in the context of training clinicians in an existentially oriented psychotherapy called meaning-centered psychotherapy (MCP) for cancer patients (for those of you who are unaware, our group at Memorial Sloan Kettering Cancer Center was recently awarded an R25 training grant by our National Cancer Institute to train a national and international cohort of clinicians in MCP, and people can enquire about the training via email: psytrainmcp@mskcc.org). “Responsibility” and “freedom” are two basic existential philosophical constructs that relate directly to the concept that we as human beings have an existential obligation to “create” our own lives. This idea derives from Kierkegaard (Reference Kierkegaard and Hong1983), who described humans as being uniquely aware of our existence, and thus having the responsibility to act on this awareness. What is our “ability to respond” to the fact of our existence? This is at the essence of the concept of “responsibility.” Existential philosophers and psychotherapists claim that we have a responsibility “to create a life,” a life that is unique to us, in which we strive to live to our fullest potential—a life of direction, and transformation, of meaning and purpose—and thus become members of a society and culture in which we are valued members. In MCP, we identify “creative” sources of meaning, or “creativity,” as all the ways in which pursuing the creation of our lives (who and what we become) contributes to a sense that our lives have meaning. So, in existential terms, Responsibility refers to our obligation to create and live a unique and authentic life, with the goal of fulfilling our fullest potential. “Freedom” refers to the concept that we are free to choose the life we create—that there is no externally given destiny or blueprint created for us, but in fact it is up to us to create our own life and who we become, potentially even transcending both the internal and external limitations we may be born with or encounter in life. “Freedom” is thus, simply put, the pursuit of authenticity in one's life, the fact that we are free to be and become ourselves. In fact, like responsibility, we can see freedom as an existential obligation as well—the obligation to be authentically oneself—to be “the author of our own story!”

We don't often think of responsibility and freedom in existential terms. In fact, when thinking of the “work–life balance,” other synonyms for responsibility and freedom more often come to mind. Responsibility often conjures up work, deadlines, worries, lack of autonomy, scheduled time, fulfilling other people's needs, living by others' rules, priorities, and timelines, bills, mortgages, college tuition, rent, health insurance, saving for retirement, alimony (sorry—too painful?), Freedom often conjures up play, fun, free time, my private life, home life, hobbies, taking care of myself, no schedule, no rules, no worries, vacations, autonomy, time for me to be me—real life.