For employees with chronic, but invisible illnesses, the decision to disclose their illness at work is fraught with risk. Many choose silence, concealing their pain behind an air of normalcy.
On 1 May, South Africans gather around braais and at union meetings to celebrate Workers’ Day — a hard-won public holiday rooted in the fight for dignity, fair treatment and economic justice.
But amid these celebrations, we must ask: Who is still being left out of our idea of the worker?
A growing number of South Africans live with chronic illnesses, many of them invisible to the eye and episodic. These workers are not on strike or in the headlines. Instead, they are quietly negotiating a daily battle: to stay employed, to be taken seriously and to survive workplaces that do not see them.
In my recent research, published in the SA Journal of Human Resource Management, I explored the experiences of South Africans living with systemic lupus erythematosus (commonly known as lupus), a chronic autoimmune disease characterised by unpredictable flares and remission periods.
This illness, like many others, does not manifest outwardly in ways that are visible or easy to understand. But its impact is undeniable and deeply embedded in how we structure, judge and reward work in this country.
Invisible illness, invisible worker
The participants in my study described a common dilemma: the decision to disclose their illness at work was fraught with risk. Some were labelled lazy. Others were perceived as unreliable. A few lost promotions or job opportunities after disclosure.
Many chose silence, concealing their pain, flares and even chemotherapy sessions behind carefully applied makeup, upbeat emails and an air of normalcy.
This silence is not compliance — it is self-preservation.
One participant told me how she went for dialysis one morning and took calls from her hospital bed that afternoon, pretending nothing had happened.
Another described how she was forced into an “amicable” resignation when her invisible symptoms began to affect her performance. Soon after her resignation she was asked to contract part-time at the same firm, doing the same work — but the damage was done.
These are not isolated stories. They are symptoms of a broader culture of workplace exclusion that thrives in the absence of understanding, flexibility and empathy.
Quiet power of workplace norms
What this research uncovered is not just a health issue — it’s a leadership failure.
Disclosure decisions were heavily influenced by organisational culture and managerial attitudes. Where leadership demonstrated compassion and an openness to difference, employees felt safer to speak up. Where managers were rigid, punitive or dismissive, employees withdrew further into concealment, often to their detriment.
We know from other research that episodic and invisible disabilities are particularly hard to accommodate in traditional workplaces, which are designed around the ideals of uninterrupted productivity and visible performance. This leaves little room for flexibility, hybrid work or shifting productivity rhythms.
As a result, workers with chronic conditions are seen as burdens rather than contributors, despite the extraordinary effort they invest in keeping pace, often at a cost to their physical and mental health.
In the face of stigma and policy blind spots, many workers simply opt out of disclosure entirely. They endure pain in silence, delay treatment to maintain attendance records or overcompensate to hide their limitations.
And because their illness is not immediately visible, their suffering is often dismissed or misunderstood.
This creates a cruel paradox: the more invisible the illness, the more effort required to prove legitimacy; the more effort required, the less energy available to do the work itself.
Psychological weight of concealment
The pressure to perform wellness is not only exhausting, it is dehumanising. Many participants in my study resisted identifying as disabled, despite qualifying under disability definitions. This resistance was less about denial and more about a desire to maintain agency and dignity in a world that equates disability with incapacity.
Yet, this also limited their access to workplace accommodations or protection under disability policy.
They were, in effect, excluded from inclusion.
This tension reveals the deep layers of internalised stigma and social expectation that shape how chronic illness is managed in professional settings. Invisibility, it turns out, is both a burden and a survival mechanism. It protects workers from prejudice but also denies them support.
We must move beyond tokenistic gestures of inclusion and start to interrogate the real cost of silence.
Practical leadership
Workers’ Day is not just a celebration — it exposes who we continue to leave behind. It challenges us to ask whether dignity in the workplace truly extends to all, or only to those whose needs fit within traditional definitions of ability and productivity.
For this to change, we need more than policy — we need better leadership.
Managers, team leads and HR professionals must move beyond a check-box approach to inclusion. They need practical tools, not just legal knowledge.
That means learning how to initiate sensitive conversations, how to offer reasonable flexibility without making employees feel guilty for needing it, and how to create team cultures where people feel safe enough to be honest about their health without fear of being sidelined or scrutinised.
Training on chronic illness should be included in leadership development programmes alongside case studies, scenario-based roleplays, and personal testimonies from affected employees. This is not just “soft skills”; it’s the foundation for psychological safety.
Creating a safe workplace is not about adding bean bags and wellness slogans. It’s about practical changes, like flexible deadlines, remote work options, check-ins that do not feel performative and absence policies that acknowledge the non-linear nature of chronic conditions.
Most importantly, it’s about equipping managers to listen without judgment, respond without defensiveness and lead with empathy.
This also requires companies to stop treating inclusion as a side project. Workers with chronic illnesses are not outliers. They are part of the everyday workforce. Their needs, be it for rest during flares, a different schedule, or protection from microaggressions, should be factored into operational plans, not left to individual negotiation.
Leadership, in this sense, means acting before being asked. It means normalising flexibility, checking your assumptions and ensuring that workplace success is not reserved for those who can pretend to be well every day.
Inclusion does not require perfection, it requires intention. The first step is recognising that the person who has never taken a sick day might not be the healthiest person on your team, but the most afraid.
A more just workplace
The world of work is evolving. Hybrid models, flexible schedules and digital tools offer real opportunities to accommodate episodic disabilities. But without a shift in attitude and accountability, these tools will remain underutilised by those who need them most.
As we commemorate Workers’ Day, let us honour the resilience of all workers, not just the ones we can see. Let us commit to building workplaces where no one must choose between their health and their livelihood.
And let us recognise that silence does not mean satisfaction, it often signals exclusion.
Invisibility should not equal erasure. It’s time we start seeing the full picture. DM
Dr Armand Bam is the head of social impact at Stellenbosch Business School at Stellenbosch University. This article is based, in part, on his recent paper ‘Invisibility, stigma and workplace support: Experiences of individuals with chronic disorders’, in the SA Journal of Human Resource Management/SA Tydskrif vir Menslikehulpbronbestuur (2025).