STRESS LEAVE: WHAT. WHEN AND HOW What to do when you've had enough The spring of 2005 was a fascinating time for the Canadian government in Ottawa. It had all the elements of a soap opera. Actually it looked like Monty Python meets the Mad Hatter's Tea Party. But out of the bizarre twists and turns came an important lesson about health. Here's a summary of what happened. Paul Martin's Liberals were clinging to power in a tightly deadlocked minority parliament. Suddenly a high-ranking Conservative, Belinda Stronach, bolted to the Liberals just before a crucial non-confidence vote. Then another Conservative, Gurmant Grewal, claimed he was approached by the Liberals to cross the floor. He even offered secret tapes as proof. But experts determined that the tapes had been tampered with. Grewal, who'd sought out the media with his allegations, suddenly tried to avoid the limelight. Finally, when the whole thing got to be too much, Grewal slipped out of sight. He called it "stress leave" The whole drama was quite a spectacle. What is Stress Leave? It's a leave-of-absence from work for mental and emotional strain. The pressure can be acute - such as a sudden marriage break-up - or it can result from a gradual build-up of stress (often at work). Finally, the person is unable to do their job properly. People who need a stress leave show symptoms in three areas: Physical symptoms usually include difficulty sleeping and lack of energy. These people are exhausted. They may also have flare-ups of new or pre-existing illness: e.g., angina, high blood pressure, colitis or irritable bowel syndrome. Richard Nixon had to be hospitalized during Watergate with high blood pressure, blood clots in his legs and high blood sugar. Mental symptoms are usually prominent: trouble with concentration, memory and ability to make decisions. Emotional symptoms include anxiety, depression, and often feelings of helplessness or feeling trapped. Unfortunately, many people don't recognize when they're under too much stress and need time off. Some lack insight into themselves. Others are in denial. They may have trouble admitting that they can't cope. It may require someone else (friend, colleague, family member or health care professional) to detect and label the problem. Sometimes it's only when the situation becomes desperate that people realize there's something wrong with them. When should you say "enough is enough"? Many folks labor on until they finally hit the wall. Bad idea. It's better to take a break before things totally unravel - especially if the stress is coming from the workplace. In this respect, stress leave is partly preventive and partly therapeutic. Timely intervention pays off. What should you do on stress leave to speed your recovery? Seek professional help. If you need to be off work, you need to be getting outside assistance - professional counseling and, possibly, medication (even if only to help you sleep). Make a clean break. Get totally away from the workplace. Don't call the office to find out how things are doing. Don't pick up work-related emails or stay glued to your Blackberry. No phone calls from the office to keep you in the loop or to ask you questions. Pretend you're on sabbatical - on some remote Pacific Island! Take the time you need. Don't go back to work too soon. I've had patients who tried to go back before they were ready and, within days, realized they still couldn't handle things and had to leave again. Develop a healthy lifestyle. Simple health habits often get pushed aside when people are overloaded with work. Returning to these basic building blocks is part of the recovery program. This includes good nutrition, adequate sleep and regular exercise. Continue these good habits even after returning to work. Diversion and distraction. The purpose of a stress leave is to rest and recover from excessive stress. Get your mind off your problems. Leisure activities are helpful: music, gardening, reading, crafts, puzzles, games, hobbies, sports like golf or tennis. Getting together with friends for a few laughs or going to the movies are great diversions. All of these activities help to restore emotional balance and are part of the healing process. Social support. Some people on stress leave withdraw or isolate themselves. This is not constructive. When people are highly stressed, the support of others is extremely helpful - for emotional comfort, caring and encouragement. Sometimes you just need someone who will listen to you. Reflect on your job and make some decisions. Getting away from work gives you perspective on your job and career. Think about your work hours, getting extra resources, improving procedures or doing tasks more efficiently. Or you may consider changing jobs to lower your stress level. Such ideas may become clearer while you're away. Plan your return to work carefully. Chat with your boss before you return. Ease yourself back slowly. Start with part-time, gradually increasing your hours and responsibilities until you're back in the groove again. It's jarring to hit the ground running after a stress leave, and a poorly-planned re-entry can trigger a relapse. When Mr. Grewal recovers, he will resurface and resume his work in Parliament. The stress leave will have restored his health. I wonder what other health lessons our politicians have in store for us.