You probably know that having a toxic job that stresses you out and sucks the soul out of you isn’t exactly good for you. As a physician who has experienced work stress myself, as well as witnessing it in my patients, it’s obvious to me that work stress is poisonous and can translate into physical symptoms. You know this already. Anyone who has ever gotten a migraine after a deal went bad or stiff shoulders after the boss criticized him can attest to that.

But did you realize that work stress can actually kill you?

In Japan, they even have a word for it—karoshi—that is defined as “death by overwork.” Karoshi usually happens to relatively young, otherwise healthy people who are burning the candle at both ends in a less-than-dreamy work environment.

The first case of karoshi was reported in 1969, when a worker died of a stroke at the age of twenty-nine. But it wasn’t until 1987 that the Japan Ministry of Labor began collecting statistics on karoshi. Since that time, Japanese officials estimate that approximately 10,000 cases of karoshi occur each year.

This should be big news! Some lawyers and scholars even claim that the number of karoshi deaths in Japan equals or exceeds the number of traffic accident fatalities each year. But when was the last time your doctor added “alleviate work stress” to your preventive maintenance or treatment plan?

What Happens Physiologically When People Die of Karoshi?

Karoshi is not a single disease. It’s a constellation of what are believed to be stress-induced physiological changes that usually lead to either sudden cardiac death or stroke, most likely caused by repetitive triggering of the fight-or-flight stress response that activates the sympathetic nervous system, raises blood pressure and heart rate, and overstresses the cardiovascular system.

Just before dying, most karoshi victims complain of varying combinations of dizziness, nausea, severe headache, and stomachache. In 95% of karoshi cases, death occurs within twenty-four hours of the onset of severe symptoms, though milder symptoms sometimes precede the severe ones. (If you’re stressed at work, do any of these symptoms sound familiar to you? If so, listen up. That’s your body telling you your work could be harming your health.)

Death by Overwork in the United States

It’s not just the Japanese who are working themselves to death. Although most of the data on karoshi comes from Japan, the International Labor Office released statistics showing that the United States far exceeds the Japanese when it comes to overwork. Our doctors and our government have yet to recognize karoshi as a distinct disease or award workman’s compensation benefits the way the Japanese do, and because we don’t track it, it’s hard to say how frequently work stress manifests as death in the United States. But you can bet it affects the health of many.

One study found that one in five Americans came to work, whether they were ill, injured, or seeing a doctor that day. The same sort of work obsession keeps about a third of employed Americans failing to use accrued vacation time. This failure to use accrued vacation time has actually been proven to predispose to early death. One study, published in Psychosomatic Medicine in 2000, looked at 12,000 men over nine years and found that those who failed to take annual vacations had a 21% higher risk of death from all causes, and they were 32% more likely to die of a heart attack. Yikes!

It’s not just early death that work stress can cause. Another recent study found that disenchanted, burned out employees developed heart disease at a 79% higher rate than those who liked their job.

And there are financial costs to all this burn out! The New York Times reports that health issues related to job stress costs the American economy $200 billion annually—roughly the economic cost of Hurricane Katrina. It is an epidemic that just might be affecting…you.

How Your Toxic Job Can Harm Your Body

You probably know that work stress isn’t good for you, and you probably know that if you hate your job, stress reduction would be a plus. But do you understand how work stress harms the body?

Here’s how it goes. Your boss yells at you when you do nothing wrong, and you get pissed. Or you’re on the floor of the stock market or in front of a jury screaming until you’re red in the face. Or you’re up all night, faced with the repetitive stress of performing a perfect surgery when you’re exhausted, like I did for over a decade. Or someone steals your idea and doesn’t give you credit. Or your job requires you to try to sell cigarettes, and when you do, you also sell out your integrity.

You keep quiet when you want to speak up. You lack the power to make the change you know needs to happen. You’re trying to please an office full of narcissists. Or whatever.

Sound the Alarm

It doesn’t matter what the stressor is. All that matters is that the amygdala in your lizard brain reads “THREAT!” and signals the alarm that lets your brain know you are in danger, probably because a tiger is chasing you. Your amygdala isn’t very smart. It doesn’t really listen to your intelligent forebrain and fails to realize that your boss isn’t actually a man-eating tiger. (Or maybe she is…)

Either way, your amygdala sounds the alarm, and the fight-or-flight physiological stress response is triggered, flipping on your sympathetic nervous system, exposing every cell to harmful stress hormones like cortisol and epinephrine, elevating your heart rate and blood pressure, and, worst of all, deactivating the body’s natural self-repair mechanisms—the ones that kill cancer cells, fight infections, repair broken proteins, slow aging, and help you live to be a hundred.

The Relaxation Response

Fortunately, your body has a natural counterbalance to the potentially poisonous stress response, which Dr. Herbert Benson famously named the relaxation response, which is also the title of his bestselling book from the 1970s. The relaxation response shuts off the stress response, turns on the parasympathetic nervous system, and flips on the body’s self-repair mechanisms so the body can do what it does best—heal itself.

Follow Your Visionary Dreams

So if you think work stress might be putting your health at risk, what can you do?

As it turns out, the most effective way to optimize the health of your body is to reduce stress responses. The average American has over fifty stress responses per day, often caused by work stress.

But what if you were doing work you really loved? When you love your work, like I do, and you’re feeling a sense of mission and purpose, helping other people with the work you do, staying in alignment with your integrity, feeling a sense of personal power in an entrepreneurial business, working with people you admire, and expressing your creative gifts, you naturally experience fewer stress responses, and the body’s self-repair mechanisms have a chance to do their business.

What if You Can’t Quit Your Soul-Sucking Job?

Still mired in the cubicle or married to the golden handcuffs? Don’t worry. In Mind Over Medicine: Scientific Proof That You Can Heal Yourself, I walk you through the 6 Steps to Healing Yourself that include not only how to reduce stress responses but also very specific actions you can take to activate more relaxation responses—things like meditation, laughter, playing with animals, hanging out with friends, getting a massage, doing yoga, attending services as part of a spiritual community, giving to others, or hugging someone.

Ultimately, it’s all about the ratio between stress responses and relaxation responses in the body, so if you can’t reduce stress responses, you can still add relaxation responses.

Is Your Work Killing You? Or Do You Love What You Do? Share your stories in the comments below.

Lucky to love my work,

Lissa Rankin

Lissa Rankin, MD is a mind-body medicine physician, founder of the Whole Health Medicine Institute training program for physicians and other health care providers, and the New York Times bestselling author of Mind Over Medicine: Scientific Proof That You Can Heal Yourself. She is on a grassroots mission to heal health care, while empowering you to heal yourself. Lissa blogs at LissaRankin.com and also created two online communities—HealHealthCareNow.com and OwningPink.com. She is also the author of two other books, a professional artist, an amateur ski bum, and an avid hiker. Lissa lives in the San Francisco Bay area with her husband and daughter.

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