License To Ill

Why do we drag ourselves to work when we’re sick, rushing back into the fray and not allowing illness to run its course?

In the Jane Austen novel Sense and Sensibility, the passionate and heartbroken young Marianne Dashwood falls ill with a “violent cold,” hovers for days in a feverish limbo, at last gradually makes a turn for the better, and for weeks thereafter is solicitously attended to as a near invalid to be protected from every care and fatigue.

Today, Marianne would be stuffed full of ibuprofen and delivering a TED talk before 24 hours were up.

Because somehow, over the course of the last few decades, the license to take ill has been revoked. The idea of lingering tucked under covers, with ginger ale and toast by the bedside and a novel propped in our hands, bears a whiff of the quaintly nostalgic, like the romance of the telegraph or the bygone pleasures of wearing spats. Calling in sick with a cold these days would be tantamount to declaring yourself a hysterical neurasthenic; get some zinc lozenges and get back to your PowerPoints, Marianne.

Perhaps we can trace the beginning of the end of sick days to the introduction throughout the 1960s of a raft of vaccines against common childhood illnesses. Certainly a gain for public health—no one who remembers them would wax nostalgic for the days of polio and measles and rubella epidemics—nevertheless, you could argue that an unanticipated side-effect was a slow-building cultural sea-change. In the past, “convalescing” meant “you would check out from the grind of everyday life,” says University of Virginia research associate professor of sociology Joseph Davis. You would “allow your body to heal, but it had a sense of being a slow process that you needed to give some time, that you couldn’t really hurry.”  

Most people over 50 can recall being laid low by one of those now rare or vanquished contagious ailments, for which, in general, the only treatment was the tincture of time. Roger Lathbury, a professor of English at George Mason University, remembers spending weeks confined to bed with the measles at the end of his sixth-grade year, in the summer of 1957, kept to a darkened room with nothing but the radio for entertainment. Though he couldn’t eat, and he missed the first week of camp, still, Lathbury also remembers the long days in that dimly-lit room as the place “where I learned to love rock and roll.”  

“Don’t we turn back with some nostalgia to those sickbed days from childhood?” writes author Sven Birkerts in Lapham’s Quarterly. “Not just because we were cared for, indulged, but also because of how in that widening eye of time the blankets became entire landscapes, and great cloud caravans moved so slowly outside the window.”

Well, not anymore, Sven. Today, time rests for no malady.

Achla Marathe, a professor at the Biocomplexity Institute at Virginia Tech, with a Ph.D. in economics, uses modeling to study the role of social behaviors in the spread of infectious disease—particularly influenza. She says that her research points to the fact that “it has become a universal expectation that even when you are ill, you are working. Society is doing it, and expecting everybody else to do it, and you have to keep up with the system. You are forced to do things that you may even know are not the optimal thing to do for yourself or for society.”

Indeed. In a separate study, 80 percent of a group of Norwegian doctors admitted to working while ill with something they would have “sick-listed” a patient for, and 87 percent of general practitioners in the U.K. in yet another survey said they wouldn’t take the day off if they had symptoms of a severe cold.

There’s a word for our insistence on dragging ourselves agued and under the weather to work and school and all our other duties and obligations—“presenteeism”—which yes, is the opposite of absenteeism, and, according to people whose job it is to measure things in dollars and cents, may actually be the more costly of the two problems. Harvard Business Review cited one study that calculated a cost in the U.S. alone of more than $150 billion, mostly in lost productivity, due to presenteeism.

Marathe’s research suggests that presenteeism exacts both a financial and epidemiological toll on our society, and that it would be cheaper for working adults to be offered—and to take—paid sick leave. But it shouldn’t take an expert in computer modeling to point out the obvious: when you show up sick, you’re going to spread the joy.

And yet, “People, whether sick or healthy, think they need to be present,” says Marathe. “Even when you are sick and at home, the general expectation is that at the very least, you can respond to email.”

“.… so you can feel better fast and get back to the job at hand,” goes the urgent pitch from a Theraflu ad that undisguisedly promotes the virtues of what amounts to masking the symptoms of your hideously contagious malaise so you don’t miss a beat at the office.

And that’s why the modern Marianne ditches her sickbed for her sales meeting, with a pocket full of tissues and a phlegmy cough like an emphysemic with a three-pack-a-day habit, and why we feel the need to stagger to our feet, hand pressed to the still-fresh appendectomy incision, fever just held in check, plaster still drying on the cast-bound leg. Because once the idea of working everywhere, all the time, became a possibility, it seems to have become a necessity. And to be idle, even when ill, starts to feel like a subversive act.

“Convalescing doesn’t sound like work,” says Joseph Davis, “It sounds like ‘relax,’ and relaxing is not permitted.”

Davis argues that we increasingly suffer from a collective unsettling anxiety about the world as an uncertain and out-of-control place where we have “deep fears about being left behind.” Co-editor of the recent anthology To Fix or to Heal (New York University Press), which considers, among other points, the creeping medicalization of our lives, Davis says that even health itself, “has become a kind of work that you have to take very seriously and you have to engage in.” And so simply to allow an illness to run its course, to take time to let yourself heal, to leave your email unchecked, is to flout a kind of “moral obligation” to do something, anything, in a culture where movement, action, never standing still “becomes an end in itself,” says Davis. “If you are standing still, you are losing ground.”

Google “what to do on a sick day,” then, and you’ll get millions of hits, many of them illustrated with stock photos of perfectly Photoshopped young women blissfully sipping from chunky ceramic mugs on the couch of their flawlessly styled living rooms. No untidy piles of mucous-clotted tissues or grotty soup-stained sweatshirts in sight to mar Pinterest’s suggested 22 DIY holiday party decorations you could make, or SparkNotes’ advice to learn to knit or to update your Facebook profile.

Martha Stewart will broad-mindedly allow you to choose between knitting or sewing. Or writing a letter. Home design website chides you not to go wasting this empty time, but rather to “make lots of lists,” including “things you want to accomplish in the next 12 months.”

Sure, the search yields some offhanded references to “rest” and “hydrating,” but since apparently we don’t even know how to suffer a cold anymore without an instruction manual, there’s a wikiHow for being ill—in 10 steps, with pictures.

And yet, here’s the irony: The optimal path to recovery might actually lead directly to your pillow. A growing body of research suggests that sleep might well be the miracle cure your mother always said it was, something Shakespeare could have told you 500 years ago.

“Balm of hurt minds, great nature’s second course, chief nourisher in life’s feast,” he called it, and if that isn’t quite the way WebMD puts it, nevertheless, he had a point.

Sometimes, it really is best to take things lying down.

For more information about the Biocomplexity Institute at Virginia Tech, go to

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