Downtime: It's Enough to Make Some People Sick
Some Research Suggests Illness Goes Up When the Stress of Work Goes Down. Skeptics Are Immune to This Theory.

By Lindsay Minnema
Washington Post Staff Writer
Tuesday, December 25, 2007

Bing Crosby was a wishful thinker. All his dreaming of a white Christmas, merry and bright, hid what the holidays often are to many busy people: sickening. But it may not be the eggnog, the endless holiday music or even the pounds of sugar cookies that are making you ill. It may be the same thing that seems to set you back when you finally head for a weekend of winter sports or jet off for a week on the beach: You're off work.

Ad Vingerhoets, an associate professor of clinical health psychology at Tilburg University in the Netherlands, calls it "leisure sickness." Just when you take a break from your busy schedule to enjoy a little relaxation, your leisure time becomes anything but -- full of aches and pains, cold- and flulike symptoms and other health complaints.


"The simple idea we have -- that when you are busy, your body is activated, and when you are not busy and have nothing to do, your body is relaxed -- is simply not the whole story," Vingerhoets said. "For some people, [a holiday or vacation] seems to be pathogenic."

Sure, some say this is pop psychology, and there are experts who are skeptical. However, even some who dismiss leisure sickness as a wastebasket diagnosis concede there is science to support the idea that unwinding is difficult for many of us.

The underlying cause of the problem, according to Vingerhoets, appears to have a lot to do with stress. He has been fielding calls about the theory since 2001, when his team of researchers reported on their survey of 1,893 Dutch people in which about 3 percent of respondents indicated that they seldom felt ill during work days but got sick during weekends and vacations. Many attributed their symptoms to difficulties transitioning from work to non-work, to stress associated with travel and to balancing a heavy workload.

Respondents who identified themselves as workaholics or perfectionists tended to have a much harder time relaxing than others.

Most explanations for the phenomenon remain unproven, however.

Paul J. Rosch, president of the American Institute of Stress in Yonkers, N.Y., and a professor of medicine and psychiatry at New York Medical College who has been involved in stress research for more than 50 years, is one of the skeptics. An inability to relax on vacations and holidays has long been a well-known characteristic of Type A behavior, he says.

Leisure represents a time when they are not in control, Rosch explains; the headaches, nausea and fatigue they might experience are a response to this stress. "It's all psychosomatic . . . not a bona fide diagnosis," he said.

But Esther Sternberg, a researcher of neuroendocrine immunology at the National Institutes of Health, disagrees. Sternberg, the author of "The Balance Within: The Science Connecting Health and Emotions," calls leisure sickness a real condition, tied to the release of hormones under stress and their interaction with the nervous and immune systems.

In times of stress, the body's adrenal glands release adrenaline, which makes the heart beat faster and causes you to feel sweaty and anxious. Adrenaline gives a boost to the immune system, the body's defense against infection, Sternberg said. But while adrenaline is pumping, so is cortisol -- a potent anti-inflammatory hormone also released by the adrenal glands.

"The reason [cortisol] works as an anti-inflammatory is because it's turning off the immune cells," Sternberg said. ". . . You're no longer able to effectively fight infection."

The two hormones are timed differently, with adrenaline starting up and shutting down within milliseconds, much faster than cortisol, which takes five to 10 minutes.

"What happens when you stop doing what it is you were doing that stressed you is that the adrenaline shuts off first," Sternberg said. "You are left with this cortisol floating around. And if at that moment someone coughs in your face, you get sick."

Don't like that hypothesis? How about this one: Vacations and holidays involve greater exposure to germs that make you sick. Then there's the psychological theory: Much of the year, busy people ignore the signals they are sick because they don't have the time to acknowledge the symptoms.

But Sternberg said stress hormones go a long way toward explaining why most people who suffer from leisure sickness on vacation experience their symptoms within the first couple of days after they stop work, a pattern Vingerhoets observed in his survey.

"There is a science to it. There is a biology to it," Sternberg said. "It's not really psychosomatic because the term 'psychosomatic' carries with it the baggage of implying that it's not really real. . . . But there is enough evidence in other settings that we can draw upon to say that leisure illness is probably a real phenomenon."

What leisure sickness lacks in empirical evidence it makes up for in anecdotal evidence.

"I have spoken with people from many countries -- from South America to Brazil to Australia," Vingerhoets said. "In all of these countries, they recognize it."

But what can be done about the syndrome?

Suena Huang, an instructor of psychiatry at George Washington University Hospital, said it may require rethinking your outlook on success.

"There's a relationship between certain personality types and the amount of perceived stress," Huang said. "Someone who's a perfectionist may impose higher expectations on himself and bring about higher anxiety on himself [than others would]. Instead of seeing perfection as the goal, perhaps seeing a balance as the goal would be one way to go -- working leisure activities and relaxation time into each day."

Huang said she sees many patients with workaholic personalities who are prone to leisure sickness. She encourages them to be more accepting of their imperfections.

Vingerhoets and Sternberg also recommend regular exercise to fend off stress.

"If you're under such chronic stress that you're impairing your immune system, you need to pace yourself, balance yourself," Sternberg said. "You can't expect to push your body to the breaking point and not have it break." ¿

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