J Health Behav Med Hist 2026-13.
The New Disease of the Netherlands: Not Working
Robert C. van de Graaf, Performance Medicine Specialist, Director
MEDTCC Institute for Health, Behaviour, Medicine and its History, and Perform Health Clinic ,The Netherlands
It is almost too strange for words.
For decades we have known that being ill is not the same as being unable to work. That sickness absence is not a disease, but a situation — a pause in the working relationship, not a diagnosis in the body.
And yet we continue to steadily build an entire care system around not working.
A stepped-care treatment model with intake, triage, referral, and aftercare.
A parallel healthcare system staffed by sickness-absence physicians, complete with protocols, evaluations, and functional prognoses.
In effect, we have created a new branch of medicine:
the medicine of not working.
It has its own consulting rooms and its own language.
People speak about work capacity, phase-1 and phase-2 reintegration.
There are treatment plans, interventions, multidisciplinary meetings.
And above all: there is funding.
Because this illness literally pays.
Those who do not work continue to receive their salary, have a right to privacy, and are protected by a system that is not allowed to ask questions about the cause of the absence from work.
The employer may ask nothing,
the employee need say nothing,
and the occupational physician mediates between two worlds that no longer look at each other directly.
A Risk Area
Thus one of humanity’s oldest activities — working — has gradually become a risk area, while not working has become a socially recognized condition.
We do not quite call it a disease, but everything about the way we deal with it breathes medicine: diagnosis, treatment, recovery, prevention.
Of course there are people who are genuinely ill, who cannot work because of their illness, where sickness absence and disease coincide temporarily or for longer.
For them, the protection of this system is valuable and justified.
But for a growing group, something else is happening.
The illness is not in the body, but in the way we have organized work.
And that may make not working the ultimate behavioral disease of our time.
A disease that settles not in tissue, but in language, rules, and habits.
A disease perfectly suited to a society that prefers to register rather than reflect,
that prefers to treat rather than question.
A Condition
The occupational physician is caught in that logic.
He treats not working as if it were a condition, while often sensing that it is something else:
a person out of balance,
an organization that has lost its resilience,
a system that has forgotten that work itself can also be part of recovery.
This is where we have gone too far.
We have turned not working into a treatable disease —
and that is exactly what we should not want.
Not working is not a disease.
It is a societal symptom,
an alarm bell from a system that is running too fast
and listening too little.
As long as we continue to medicalize it,
we will create more practitioners,
but less healthy work.
And perhaps, if we are honest,
that may be the most unhealthy thing of all.
Translation from: De nieuwe ziekte van Nederland: niet-werken (Arts en Auto)