In October last year, I swayed on my feet, sweating, before a packed room of academics and students. My lungs felt bruised and ticklish with each ragged breath, my limbs beamed with soreness. A few days into a bout of influenza, I was about to give an hour-long talk about my research. Coughing and spluttering in a poorly ventilated room, I somehow got through the presentation and the subsequent hour of questions, cried off the dinner invitation and went home to collapse into bed, where I’d remain for the rest of the week.
Why did I spend two hours in a crowded room with flu? Because I wanted to honour a prior commitment, and because I didn’t think the organisers would believe me.
We prioritise saving face over recovering
Feeling like my illness won’t be believed dates back to my early childhood. My sisters and I would assume each other’s illness was fake, part of a ploy to miss school or get some attention. How to prove otherwise? There were two acceptable forms of evidence. The gold standard was vomit. If you threw up, you were poorly, fair and square. Second was to refuse particular food. Turning down cheese on toast, crisps, or sweets was tantamount to having a doctor’s note. Once presented with this proof, we’d lovingly nurse each other, pressing cold flannels to febrile foreheads, bringing steaming mugs of lemon and honey, making elaborate get well cards. Without evidence, you were a liar who was to be shunned until you gave up the charade.No surprise then that now I’m an adult who struggles to take sick leave. But I’m not alone: as a nation, we tend to prioritise saving face over taking time off. British people take just 4 sick days per year, compared to a European average of 10 days. This number has halved from 8 days since 1993, and is now as low as it has ever been.
There are lots of reasons why people work when they’re unwell: not having sick pay, being precarious, being overworked and perpetually behind. Social factors play a significant role: 86% of workers report a culture of "presenteeism"—one that valorises showing up above all else—within their workplace, and worry that their managers and colleagues will be mistrustful or judgemental about their illness, or will expect them to come in regardless. And they’re right: just 42% of managers feel that flu is an appropriate reason for taking sick leave.
This culture of disbelief around illness is systemic and political. In 2011, then-prime minister David Cameron condemned the UK’s “sicknote culture” as a drain on resources, thereby entrenching the idea of illness as excuse.
This culture of suspicion around illness extends to social engagements, where the fear of being a labelled a “flake” leads many of us to suffer in silence or infect friends and relatives rather than risk being seen as unreliable. Being taken seriously requires visible symptoms, a doctor’s note, or pulling out of something we’d evidently really enjoy. Not so different to the dubious standards of evidence myself and my sisters applied as children.
Challenging presenteeism
The effects of mistrusting the illness of others are morally serious. Philosophers working in the area of social epistemology have explored the injustice of not being believed when one should be, of having one’s testimony unfairly deflated because of the prejudices of others. In the case of infectious illness, not only is the sick person wronged by not being believed, but this disbelief can also endanger the health of others.Though they’re distinct situations, mistrusting illness invokes some of the same moral issues raised by mistrusting victims of sexual assault. Statistically, the odds are clear: people don’t lie about rape any more than they lie about any other crime; people are much more likely to go to work when they’re ill and pretend they’re okay. In both cases, not believing people makes it even harder for others to disclose in the future.
Our priorities are backwards. We place our personal reputations and work targets above the health of others, and are encouraged to do. Infecting someone with flu, as I surely did that day back in October, is a grave harm. It is far worse than me being unfairly seen as an unreliable visiting speaker. Anyone in the room that day with an underlying respiratory disease was at risk of hospitalisation, or worse. Lighting a cigarette would have been less harmful.
The government and employers must shift our culture by providing people with the material resources and guidelines to enable them to stay at home when they need to. Managers must model responsible behaviour by taking time off when they’re unwell. We have to change the way we talk about and respond to "presenteeism." I need to stop commending students or colleagues who show up when they’re infectious: they’re not “troopers” who are “soldiering on,” they’re a risk to others and should be sent home. Above all, when someone says they’re ill, we should believe them, wish them well, and if it’s infectious, encourage them to self-isolate.
Letting go of the stiff upper lip
Back in 1995, reflecting on the lessons learned from the AIDS crisis, philosophers John Harris and Soren Holm wrote the following in the British Medical Journal:[su_quote]“The moral duty to behave responsibly and not knowingly put other people at risk is […] a duty which all people with communicable diseases have. It is, however, also a duty which we can expect people to discharge only if they live in a community that does not leave them with all the burdens involved in discharging this duty.” [/su_quote]
We do not yet live in such a community, and the current crisis has found us recklessly unprepared. Critical time was lost before measures such as the provision of sick pay and income for the self-employed were passed, thus leaving many people to choose between maintaining a basic livelihood or staying home.
After all this, we will need to carefully examine the larger, more diffuse burden posed by our assumptions about illness and infection, and recognise that the stiff upper lip fortitude we look for in ourselves and others amounts to dangerous hubris and cynicism of the kind we should all leave behind in childhood.
