Breaking the Connection Between Anxiety and Sick Days

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The idealized version of childhood illness paints a rosy picture of a mildly sick child swaddled in pillows and blankets and doted on by their loving mother. A more realistic version is simply of the child home alone, pills, water, and soup available while they doze, read, watch TV, and play video games (unless they’re faking. Then this is just a relaxation day.). Either way, the concept of a “sick day” is about ministering to the child and helping them feel better in a safe, nonjudgmental way.

My experience was somewhat different. Sick days generally meant spending the morning lethargically getting ready while agonizing about if you were really too sick to go to school and if you would miss something critically important that would flood you with guilt. Even if you did decide you were too sick to go, your day wouldn’t be relaxing. You would spend it holed up in your room, barely daring to move, trying to make as little sound as possible, hoping your father would go to work before he’d realize you were there or go on a daylong errand. You’d strain your ears for the sounds of him getting ready, hearing the cereal pour into the bowl, listening to the squeal of the pipes as he took a shower, hearing the radio blaring through the walls, concentrating on his footsteps as they took him past your room. Sometimes you couldn’t make it – you’d have to go to the bathroom or get some lunch or cough too loudly, and he’d know you were there. At best, you’d get a mild interrogation – “Why are you home from school? What are you trying to miss? Are you really sick? What do you have?” before he’d leave you alone. At worst, he’d burst into your room, already angry, the thick vein bulging from his forehead, eyes as blue and wide as a husky’s. Then you’d wish you’d just gone to school. Even throwing up all over everyone’s desks like you did in first grade would be better than this.

For the majority of my life, getting sick has meant feeling anxious. It has meant second-judging your instinct to minister to yourself. It has meant feeling guilty about letting someone down. It has meant being afraid of being punished. It has never been fun or relaxing.

I have so many memories of pushing myself too hard when I was sick. In junior high, I took off all week for the flu but insisted on going to UIL, an academic contest that I loved. It was a miserable day, and I tanked at least two of the events because I just couldn’t concentrate. I also made myself sicker and had to take off the next week because I got an ear infection and my eardrum ruptured.

Or during my senior year of college when I was down for almost three weeks because I got a massive stomach virus. I actually made myself walk around campus turning in my assignments and personally handing in doctors’ notes because I didn’t want my professors to think I was slacking. One professor glanced at me as I wobbled into her office and told me she was going to call someone to escort me back to bed – she didn’t think I could make it.

When I was teaching in Ukraine, I often walked the thirty minutes to school in windy, freezing temperatures while down with a cold or stomach bug. I would spend the time between classes cluttering up the teacher’s lounge with used tissues and breathing heavily through my mouth. Teachers would take me aside and ask if I were dying and if I needed to go to the hospital. No one thought it was safe or healthy to be out, and they gossiped about me for days, resulting in my counterpart, the entire English department, and the Peace Corps regional manager calling me to tell me to stay home and take care of myself.

By and large, there has been no reason for me to punish myself when I’ve been sick. I’ve been fortunate enough to work at places that value my health above my productivity (and when I worked fast food and retail, it was for short enough periods that getting sick wasn’t likely), but I came from a family where that wasn’t the case. I remember my mother stressing out when she had to call in because one of us was sick and how she would argue with her employers about needing to stay home – only to have to leave us anyway. Ingrained with the sense of guilt and fear that my father instilled was the idea that taking even one day off could result in you losing your employment – and then you couldn’t pay for food, rent, or utilities and you’d end up losing your apartment and having to live on the street where you’d get sick and die in short order. While there is an element of truth to that hyperbole, it’s not instantaneous, it’s not a foregone conclusion, and it’s not even very likely.

Psychodynamic psychotherapy is a form of psychology whose focus is to the reveal the unconscious content of someone’s psyche. This uncovering is meant to alleviate psychic tension (i.e., depression, anxiety, etc.). Talk therapy is not the only component of it; rather, there’s an element of challenge to it. The therapist challenges the client’s understanding, challenges the things they hold as “Truth,” and challenges them to change their perceptions and behaviors in incremental but ultimately necessary and helpful ways. According to this practice, understanding where my anxiety and guilt comes from in relation to taking sick days is supposed to help me be able to lessen that anxiety and guilt. At least, that’s what my ex-therapist said.

However, I’ve long understood the correlation, but it is incredibly difficult to break thought patterns and synaptic connections you’ve had for over 20 years. And given my borderline tendencies (which is a topic for another day), understanding and challenging my perceptions can actually be harmful. I dig in my heels and resist when I feel criticized, and my thoughts reinforce each other, whether by deriding the qualifications of the person trying to help me or by simply refusing to admit that my reasoning may be faulty, which then feeds on itself and makes me feel worse.

Of greater help to me (and I would argue for most people) is pure validation. Validation is when you understand and support the way someone is thinking, feeling, or acting without judgment. It’s different from approval, which is inherently judgment-based. An example would be someone freaking out about losing their job, and you nodding and saying something like, “That’s sounds tough,” “I understand how you feel,” or “Yes, it can be overwhelming.” You allow the other person to feel their feelings, and you show that their feelings are valid. You don’t dismiss them. You don’t trivialize them. You don’t brush them away. You don’t try to take the attention off them. You acknowledge them and their pain, which helps them integrate the understanding that their thoughts, feelings, and actions are worthwhile. Once the person manages that, they can begin the process of learning to change their thoughts, feelings, and actions.

It sounds so simple, but it’s really revolutionary. So many of our common interactions involve judgment. When someone gets a promotion, we say, “That’s amazing! I’m so proud of you! You’re awesome!” When someone talks about an altercation with someone else, we can say, “Well, that’s what you get for shooting your mouth off,” or, “How could you be so stupid?” When someone is bitching about their job or feeling restless, we say things like, “You do know there are starving kids in Africa, right?” and, “I know! It’s like this one time when I was trying to finish this project…” As a society, we have the tendency is judge, dismiss, and invalidate others, even when that’s not our intention. It’s ingrained in our thought and speech patterns.

For the past 18 months, I’ve been working at a place I love at a job I love with people I love. Small irritations crop up, and when I’m feeling sick or uncomfortable, I do have a tendency to stream-of-conscious complain. But overall I wake up excited to do what I do. I leave work bubbling with news of what I did. I smile naturally. I take new responsibilities freely. I’m not planning an end date. I’m just happy.

A large part of my happiness is my manager, who follows the radical management technique of trusting her employees and knowing that their personal needs come first. She accepts when we need to take off sick or leave early to take care of a child. She approves our vacation requests and sends our program ideas up the ladder. She’s constantly asking, “What do you need? How can I help?”

Whether she knows it or not, she’s done a great deal to alleviate my anxiety about taking off sick. Every time I call in, she says things like, “Do what you have to do,” “Take care of yourself,” and “That sucks. Feel better!” They are small actions and short sentences, but they do a great deal to validate the notion that my body is deserving of care and rest. As a result, I have significantly less anxiety about calling in or leaving early. I send her significantly less information about my current illness. I don’t wake up from an afternoon nap feeling guilty about missing a delivery or story time. When I do come back after an illness, I don’t push myself as hard as I used to, making it more likely that I will be weak for even longer. I take care of myself and finally understand that the job will wait 24 hours or 72 hours or a week. I come first.

I also understand what a privileged position I’m in. While I am not yet salaried, I do occupy a unique position with a great deal of autonomy and have a steady paycheck. I am not a cog in a machine, which can only function if every single member is present. I am free to more or less make my own schedule, canceling and rescheduling deliveries and events at my discretion. I have excellent benefits, including a good amount of vacation, sick days, disability, and federal protection. I enjoy the support and approval of my manager, coworkers, and organization, and given my unique position and my organization’s budget, I have a decent amount of job security. This will not be the case everywhere. My supervisor will not always think my health or I come first. However, my current manager’s validation is important to me right now. It is a necessary balm for my psyche, and every instance of validation will help strengthen my resolve and emotional regulation. It will make it more likely in the future that I will be able to tell an employer that I cannot come in because I’m sick or I need to take off because of a surgery. It will be real, concrete proof that my health is important and I will not automatically lose my job and ruin my life when I need to take a day off. It is a small thing but so important, and I feel so lucky to have it in my life.


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