“Symptom Bearers”

"silence" (CC BY-NC-SA 2.0) by RebeccaBarray

Understanding the Concept

In family systems and by extension, in schools, the term “symptom bearer” (or Identified Patient) refers to an individual—often a child (student)

—who unconsciously becomes the focal point for tension, stress, or unaddressed dysfunction within the group. In workplaces and social settings, we often see similar dynamics:

• A colleague or acquaintance begins to visibly exhibit stress symptoms (e.g., irritability, withdrawal, physical pain or fatigue).

• Others may unconsciously use this person as a stand-in for broader group anxieties or organizational dysfunction—a “symptom bearer.”

• The individual’s symptoms then prompt reactions or coping behaviours from others, which shift attention away from structural or relational issues impacting the group.

How It Manifests in Everyday Settings

• Visible vs. “Invisible” Conditions
  Many conditions that lead someone to become a symptom bearer are invisible (e.g., chronic pain, fibromyalgia, or mental health challenges). The person’s suffering is real but not self‑evident, requiring them to engage in what scholars call credibility work—performing or conveying their symptoms to be recognized as legitimate (Werthner et al., 2021; Murray & White, 2021).

• Social Negotiation of Symptoms
  When someone discloses symptoms at work, their legitimacy depends not just on their own account but on the responses of colleagues and supervisors. Without a shared framework or vocabulary—“I had migraines and was unproductive”—symptoms may be dismissed or misunderstood (Murray & White, 2021).

• Stigma and Social Exclusion
  Coworkers may perceive the symptom bearer as unpredictable, incompetent, or less warm, which can trigger distancing, exclusion, or microaggressions (Broussine & Miller, 2005; Beatty & Joffe, 2006). This mirrors stigma dynamics seen in chronic mental illness in workplaces, where individuals with visible symptoms are more likely to experience negative stereotyping and reduced social support (Hewitt et al., 2017).

• Presenteeism & Burnout
  People who are symptom bearers often continue working while ill (presenteeism) due to pressure or fear of career impact. Yet their productivity suffers, and stress can escalate into burnout or depressive symptoms (Lohaus & Habermann, 2019).

Why This Happens

• Organizational Culture & Psychosocial Safety Climate (PSC)
  Where psychological health isn’t prioritized, or senior leadership doesn’t convey support, symptom bearers go unrecognized or unsupported. A poor psychosocial safety climate is associated with increased absenteeism, burnout, and presenteeism (Dollard & Bakker, 2010).

• Lack of Supervisor Support
  Supervisors often lack the tools to respond empathetically to subtle emotional or physical cues. When the individuals who check in do have personal experience or empathy, employees report feeling more understood and secure (Werthner et al., 2021).

What Research Tells Us

• Disclosure vs Concealment
  Workers must decide whether, when, and how to disclose invisible conditions. Disclosure can lead to accommodations and support—but also risk stigma and strained relationships. Those who were symptom bearers and had empathetic, experienced managers tended to receive more support (Werthner et al., 2021; Hewitt et al., 2017).

• Daily Impact
  Research using daily diary methods shows that fluctuations in symptom severity—e.g., pain, fatigue—predict how people experience social interactions daily. These fluctuations shape how others respond, and how supportive or alienating the social environment feels (Zautra et al., 2007).

• Self-Help and Helper Theory
  Some symptom bearers may also take on helper roles—supporting others with similar conditions. Helper Theory suggests that helping others can boost one’s own well-being and self-efficacy—though this dynamic depends on context and mutual trust (Riessman, 1965).

We live and work beside people who are silently carrying pain—chronic illness, mental health struggles, emotional fatigue. You won’t always see it. You won’t always hear about it. But it’s there.

And too often, we judge them for being “difficult,” “withdrawn,” or “inconsistent,” without realizing they’re absorbing the stress we all pretend doesn’t exist. These people—“symptom bearers”—are not weak. They’re often the canaries in the coal mine of our workplaces and social circles. Their suffering points to deeper issues we collectively avoid: unhealthy culture, poor communication, and lack of psychological safety.

We cannot afford to ignore or mislabel these individuals. Not just because it’s unfair to them—but because the health of any group depends on our ability to recognize and respond to what’s really going on, not just what’s easiest to see.

If someone seems off, don’t jump to conclusions. Instead, ask: What might this person be carrying that no one else is naming?

When we stop blaming the symptom bearer and start listening, we don’t just help them—we start healing the system.

---

Bibliography

Beatty, J. E., & Joffe, R. (2006). Chronic illness in the workplace: Stigma, identity threat and strain. Journal of Management Studies, 43(2), 329–352. https://doi.org/10.1111/j.1467-6486.2006.00586.x

Broussine, M., & Miller, C. (2005). Emotions in the workplace: The neglected side of management development. International Journal of Public Sector Management, 18(6), 436–445. https://doi.org/10.1108/09513550510616780

Dollard, M. F., & Bakker, A. B. (2010). Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement. Journal of Occupational and Organizational Psychology, 83(3), 579–599. https://doi.org/10.1348/096317909X470690

Hewitt, A., Howlett, S., & Bardwell, G. (2017). Chronic illness stigma and its relevance in the workplace. In: Pathways for Wellbeing. ResearchGate. https://www.researchgate.net/publication/318726594

Lohaus, D., & Habermann, W. (2019). Presenteeism: A review and research directions. Human Resource Management Review, 29(1), 43–58. https://doi.org/10.1016/j.hrmr.2018.02.010

Murray, J., & White, K. (2021). Communicating chronic illness in the workplace: The social negotiations of invisible illness. Critical Health Psychology. https://oercollective.caul.edu.au/critical-health-psychology/chapter/chapter-2-2

Riessman, F. (1965). The "helper" therapy principle. Social Work, 10(2), 27–32.

Werthner, L., et al. (2021). Workplace experiences of employees with chronic illness: A qualitative exploration. Journal of Occupational Rehabilitation, 31, 692–707. https://pubmed.ncbi.nlm.nih.gov/34308263

Zautra, A. J., Affleck, G. G., Tennen, H., Reich, J. W., & Davis, M. C. (2007). Dynamic approaches to emotion and stress in everyday life: Bolger and Zuckerman reloaded with positive emotion. Journal of Personality, 75(6), 1511–1538. https://doi.org/10.1111/j.1467-6494.2007.00457.x