In order to “graduate” from the outpatient psychiatric program of Laurel Hospital in Maryland, we had to demonstrate a certain level of competence at assertion skills or confrontation. It’s no wonder it took me three times longer to be discharged than the other patients.

One day an older woman sat in the middle of the circle. She looked very tired and drained. Her daughter had been dumping her kids off at her door in the morning and leaving them with her until late in the evening. Since the woman was battling different medical conditions, this was very hard on her health, and prevented her from getting the rest she needed to recover.

“Take these kids,” the nurse said to the woman and pressed on her shoulder.

The woman didn’t say anything.

“What do you say?” the nurse prompted her.

“I won’t be home until late tonight,” the nurse said and pressed both of her hands on the woman’s shoulder.

“Ouch,” she said to the nurse.

“I’m not going to stop until you learn how to assert yourself,” the nurse said.

It took four physical movements for her to finally get it, and then she said, “I’m sorry, but I won’t be able to take the kids today. I need some time to recover.”

“Good for you!” said the nurse and we all clapped.

The two nurses taught us about the emotional and physical ramifications of being a so-called “nice guy” and the toll our bodies pay if we don’t “use our words,” as I used to tell my toddlers.

For starters, anger-not-claimed floods our bloodstream with cortisol and produces proteins that can literally shrink the brain. Resentment can activate the amygdala, causing us to exist in a kind of permanent fight-or-flight state, which weakens our immune system, creates inflammation in the coronary arteries, and triggers a cascade of problems in just about every biological system. The chronic stress that comes with being a clinical people-pleaser can actually cause mental disorders with its detrimental effects to the prefrontal cortex, and it can certainly prevent a person from getting well.

As I watched the nurse push down on the woman’s shoulder until she spoke the magical words (“I can’t!” and “Stop doing that!”), I finally got it. I have always been deathly afraid of confrontation. My mom nicknamed me “pink powder puff” as a kid, akin to “little doormat.”

As in most alcoholic homes, there was no effective communication happening whatsoever. Disagreements ended with one person leaving and not coming back. Whenever I did get the courage to say something candid, it was usually followed by a very long, painful silent treatment. So I learned not to say anything.

In her book The Dance of Connection: How to Talk to Someone When You’re Mad, Hurt, Scared, Frustrated, Insulted, Betrayed, or Desperate, Harriet Lerner, PhD, writes:

“Speaking our mind and heart is the most precious of human rights. The ability to speak our own truths forms the core of both intimacy and self-regard. The poet Adrienne Rich puts it beautifully: It is not, she writes, ‘that we have to tell everything, or to tell it all at once, or even to know beforehand all that we need to tell.’ But an honorable relationship, she reminds us, is one in which ‘we are trying, all the time, to extend the possibilities of truth between us … of life between us.’ When we are not able to speak authentically, our relationships spiral downward, as does our sense of integrity and self-regard.”

It admittedly still takes me four or five pushes on the shoulder before I say anything. When someone posts a direct insult to me on Facebook or on my website, I try to let it go. If it happens again, I try harder to let it go.

Only around the fourth time do I start visualizing the woman in our psychiatric program getting pushed by the nurse. I then remember why we must assert ourselves: Staying quiet prompts poison to run through our bodies, preventing us from healing. For the sake of my health, I say: “PLEASE UNSUBSCRIBE TO MY BLOG IF IT MAKES YOU THAT UPSET! Do not continue to write nasty comments. I am worth more than that.”

It feels good when I can gather the courage to do it. Each time I dare confront someone, I become truer to myself. The fact that the world didn’t stop when I spoke up, and readers are still commenting, and there are websites that still want me to write means that I can attempt to be assertive more often without risking complete deterioration of myself and my relationship with others. I find out that I am safer than I thought to try to act in my relationships with complete integrity.

“Our conversations invent us,” explains Dr. Lerner. “Through our speech and our silence, we become smaller or larger selves. Through our speech and our silence, we diminish or enhance the other person, and we narrow or expand the possibilities between us. How we use our voice determines the quality of our relationships, who we are in the world, and what the world can be and might become. Clearly, a lot is at stake here.”

Sometimes a little confrontation is good for us.

At the very least, it gets you out of the hospital.

Join the discussion on Project Beyond Blue, the new depression community.

Originally posted on Sanity Break at Everyday Health.

Woman asking “who me?” photo available from Shutterstock