Sick Leave, Shame, and the High Achiever
Publish date: Friday, October 16, 2026 | Category: Mental Health | Read time: 9 min read | Author: Carolyn Charest, MC, R.Psych
"I'm a high achiever. I always meet my goals and work hard to get there. Struggling with my mental health feels like an excuse."
I've heard some version of that from many clients, usually in the first week of a medical leave. The words here are a composite, with details changed, but the feelings behind them show up again and again. "I feel weak." "I don't trust myself anymore." "I don't know who I am now." And the one that keeps people awake at 2 a.m.: "Everyone is going to think I'm gaming the system."
If that sounds like the voice in your head right now, here's what I tell clients in that first session. Admitting you can't keep going at the same pace takes more strength and courage than pretending you can.
Why it hits high achievers harder
When your identity is built on delivering, sick leave can feel like a performance review you failed. Researchers in London interviewed 19 doctors who had been off work for at least six months for physical or mental health reasons. Self stigma sat at the centre of their stories, and several described themselves as failures. The authors suggested this may come from the belief that doctors are invincible (Henderson et al., 2012). Swap "doctor" for "VP" or "founder" and the dialogue sounds familiar.
Self stigma tends to build in stages: you know the stereotype about mental illness, you agree with it, you apply it to yourself, and then it starts to cause harm. Researchers use the term "why try" effect to describe one of the ways that harm shows up. Self stigma chips away at self esteem and confidence, and people start pulling back from goals that matter to them. A 2023 study of 208 people living with depression or bipolar disorder found this effect was one of the ways self stigma made everyday life harder (Qin et al., 2023). "I don't trust myself anymore" is ultimately what people tend to tell themselves.
Shame can keep you off work longer
Shame is more than an uncomfortable feeling to push through. A Swedish study surveyed people on long term sick leave and linked their answers to national sick leave records. People off work for a mental illness reported more shame than people off for a physical illness. Those with high levels of shame were more likely to have prolonged sick leave the following year, and depression symptoms only partly explained that link (Knapstad et al., 2014).
I see this all the time in my work as a psychologist. Someone takes leave, starts to feel a little better, and then the guilt sets in. They spend their energy replaying what their team must think of them instead of resting, and their recovery slows down. The shame they feel about being off work becomes one of the things that keeps them off work.
White knuckling has a cost
High achievers are skilled at gritting their teeth and carrying on. That skill earns promotions, and it also has a ceiling. When you push through a mental health condition without support, the cost rarely stays with you alone. Your team feels it in your shorter fuse and slower decisions, and your family feels it when you come home with nothing left in the tank.
Sick leave gives you a chance to step back and look honestly at which habits still serve you and which ones are wearing you down. The aim is a life and a workload you can sustain, so you aren't back in the same spot next year.
Your health information belongs to you
A diagnosed mental health condition is a medical issue, and it deserves the same privacy as any other health condition. BC has privacy laws that protect employees' personal information, including their health information (Employment Law Alliance, 2024). Taking time off to treat a health condition is part of doing your job responsibly, which is a long way from gaming the system.
If you have questions about your own situation, your HR team or an employment lawyer can walk you through how the rules apply to you.
Your colleagues aren't entitled to your story. You decide who knows what, and you're allowed to set that boundary.
Benefits and paperwork
Paperwork can be its own hurdle. Filling out a claim can feel like admitting you're "really" sick, and it's easy to leave the forms on the kitchen counter while the bills keep coming.
If your employer offers group benefits, your plan may include short or long term income benefits, which your insurer may call disability benefits. Your treating practitioner completes a form that includes your diagnosis, and it usually goes to a case manager at the insurance company rather than to your manager. The case manager reviews your medical information and manages your claim, and they're also the person to call with questions. Ask your benefits provider who receives the form, who pays any fee for completing it, and what deadlines apply. It's also reasonable to ask how your details will be handled and who will see them.
If you don't have group coverage, or your plan doesn't cover your situation, Employment Insurance sickness benefits may help. You'll need a medical certificate, which a doctor, nurse practitioner or psychologist, among others, can sign, and Service Canada can tell you whether you qualify (Government of Canada, 2026).
Book an appointment specifically for the paperwork and bring the forms with you. Be open with your doctor about how you're really doing. In my experience, high achievers tend to downplay what they're going through, and your care provider can only help with what they know.
Nobody is watching as closely as you think
When people on sick leave start thinking about going back, the worry I hear most often is what to say to colleagues. People rehearse every awkward conversation in advance, and sometimes that fortune telling keeps them from going back at all.
Here's what they often miss. While they're away, the company keeps moving. New projects start, other people have their own crises, and the situation that felt enormous when they left has faded for everyone else. The person on leave is usually the only one still replaying it.
There's a name for this blind spot. In a series of experiments, Gilovich et al. (2000) found that people consistently overestimate how much others notice their appearance and actions, a bias they named the spotlight effect. In one study, participants who walked into a room wearing an embarrassing shirt overestimated how many people would remember it.
You don't need a speech. One line will do: "I've been away due to a health condition, but I'm feeling much better now. Thanks for asking." Then change the topic. Most people will follow your lead.
Decide what to share before anyone asks
Some people tell only HR. Some tell one trusted peer, and a few choose to speak openly. Each option has trade offs, and a structured way of deciding can take some of the pressure off. Picture a VP heading back after two months away. She could tell her whole team, just the one peer who covered her projects, or nobody beyond HR. None of those choices is wrong. What matters is that she decides ahead of time, so she isn't caught off guard when a colleague asks in the hallway.
You can do the same before you go back. Write down who needs to know, who you'd like to know, and who doesn't need to know anything at all.
Turn down the volume on the inner critic
The voice calling you weak is usually far harsher than anyone at the office would be. A systematic review of 29 randomized trials found that approaches built on self compassion or acceptance and commitment therapy look promising for reducing self stigma and shame. Most of those studies had design weaknesses, so the evidence is encouraging and still early (Stynes et al., 2022).
A practical place to start: when the internal critic says "you're weak," ask what you'd say to a friend who took leave for the same reason. Then say that to yourself.
Coming back on your own terms
Taking sick leave for your mental health is a medical decision, made by someone responsible enough to notice they needed it. Shame can make that decision feel like something to hide, and the research suggests it can keep people off work longer than their health requires. Work is often a big source of meaning, structure and confidence for high achievers, and in my experience, the longer they're away, the harder the return tends to feel. The goal of sick leave is to recover well enough to get back to the work you care about, and the right time to go back is a decision to make with your care team.
If you're on sick leave or getting ready to go back, and the shame is making it harder, I'd be glad to help you work through it. You can book a virtual session from anywhere in British Columbia, or meet in person in North Vancouver, at wellflow.janeapp.com. If you're in crisis, call or text 988, or go to your nearest emergency department.
This article is general information and isn't a substitute for individual care.
Carolyn Charest, MC, R.Psych
