Are passive and aggressive people more likely to suffer health problems than assertive people? If so, why is being assertive so good for our health? What can you do to improve your levels of assertiveness and, therefore, your health?
Imagine having a life-threatening physical illness and being so unassertive that you were unwilling to ask for help.
Would that harm you? Yes. “Surely,” you may ask, “no one” would be unable to ask for help in such circumstances?” Alas, not; help-seeking reluctance is very real and costs lives.
How many people are so unassertive? Frankly, we don’t know. Why? Because they are no longer alive to answer questions about the cause of their reluctance to ask for help.
We do know that some people don’t ask for help because they “don’t want to make a fuss,” meaning that they consider asking for help would inconvenience others. That is passivity-induced self-destructive behaviour.
Even medical professionals are reluctant to ask for help, especially mental health help. Why? They worry that declaring they need mental health assistance will impact their careers. And they are right to be concerned; there is still huge prejudice against mental health problems, even though in any one year, 25% of people will experience such a problem. Over a lifetime, one in two people will personally suffer mental health problems.
Most medical professionals are aware of those figures and will still not assert their need for help.
Even when passive people become ill, and are helped, whether they have asked for it or it has been required, their lack of assertiveness goes on to cause more problems.
Every year huge numbers of people die of medical negligence. An unknown number of those fatalities are caused by passive patients abdicating responsibility for their health to the physician. “That’s the doctor’s job” is a common justification for their passivity. “I don’t know anything about medicine” is of the same ilk. Both come from a mindset of passivity; both lead to the physician not being given full information, not being challenged when they make false assumptions, and not being confronted about treatments that are likely to harm a patient.
If the person needing help perceives that those they need to ask for assistance are unapproachable, unhelpful, gaslighters, dismissive, or otherwise psychologically toxic, they are even less likely to ask for help.
From their facial expressions and body language, you may have observed people in help provision roles who make it very clear that help is the last thing they want to provide.
You may also have seen some consultant doctors whose modus operandi is “never to be wrong”, treating nurses, patients and other staff with contempt.
In both of the above examples, it takes an assertive person to ensure they receive the right help in the right way.
The attitude of the “helper” can determine what level of assertiveness is required in the person in need to receive the needed help. If the person needing help falls below the level of assertiveness to trigger help, it can have fatal consequences.
When people make decisions, their motivations play a part in their decision-making. They conduct a cost-benefit analysis and a risk-benefit analysis. If a non-assertive person perceives that the emotional cost and psychological risk they face for speaking up to express their needs or concerns is too high, they will remain silent, with possibly grave consequences.
Even in intimate relationships, a lack of assertiveness kills. How many people have not checked the sexual health status of a sexual partner because they could not assert their right to self-protection?
How many did not ask? How many allowed sex without protection because they felt unable to assert their right to sexual health protection by insisting on using protection? How many are dead because they did not assert themselves? We do not know the number, but it seems reasonable to think that the number is very large.
It takes an assertive person to speak up and stay safe in such situations. Those who do, prevent avoidable risks from destroying their lives. Assertiveness is a lifesaver in many contexts.
Understanding why people put their lives at risk by not seeking help could save lives.
Is it because they do not have the intention, or they do not have the skills to express their intention? Both. And they may be connected.
If someone has had a lifetime of being unable to ask for help because of their lack of assertiveness, they are less likely even to form an intention to assert in their minds.
We have known for some time that people who are prepared to express their subjective needs (personal preferences) are more likely to seek help for objective needs (in health and other areas).
It seems to me that the mediating variable here is assertiveness and, more specifically, the beliefs and skills that make up assertive behaviour. Assertive people will be more likely to express their subjective and objective needs.
Assertiveness seems also to enhance the level of social support that a person in need can access and receive for any health challenge.
When people are socially assertive, they are more directive and independent in defending their own interests. If they are assertive about their health, they can stay healthier for longer.
Friends like to be pleasant to each other. If one friend in a group is overweight and is trying to return to optimal health, they may find that when eating together, their friends will note the restricted diet and say things such as, “A little won’t hurt,” or “You need a treat now and then.”
Alas, it is the cumulative effect of “a little treat every now and then”; over a long period that has done the damage.
In some cases of morbid obesity, the person has one or more “feeders,” that is, people who offer food, and the obese person is not assertive enough with themselves or others to decline. Each failure to assert contributes to the kilos.
By contrast, some assertive people can happily socialise with friends and declare: “I am intermittently fasting today, and as such, won’t eat anything. Although I will savour your wonderful company.”
Even if their friends offer food or feel uncomfortable eating in the presence of someone who can fast, at will, the assertive person will do what is right for them.
Are those at the other end of the continuum, aggressive people, more likely to suffer health problems?
Yes, we have known for a very long time that people who have high levels of aggression are harmed by the toxic chemicals that such aggression releases into their bodies. They are more prone to high blood pressure, strokes, heart attacks, and other self-induced stress-related illnesses.
What can aggressive people do to protect their health, largely from themselves?
Learn how to be assertive rather than aggressive. Is it important for them to do so? Only if they see the choice between life and death as important. Some ambitious, aggressive people have long since accepted that the price they will pay for achieving their goals is a premature death or at least a much higher risk of such a demise. They are OK with it. Many are unaware that they also take on a higher risk of mental health problems.
Calmly assertive people have the best health and well-being outcomes in almost every well-being context. We each have a choice.
- We can be passive, and not speak up for our needs, and suffer the health consequences of passivity.
- We can be aggressive, and be disregarding of those around us, and achieve our goals at the price of higher health risks.
- Or, we can be assertive, express our needs and concerns clearly, calmly and directly, and maximise our chances of good health.
Which will you choose?
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.