The world-renowned family therapist Virginia Satir used to wear a medallion around her neck. The word yes was emblazoned on one side of the medallion, and on the other side, the word no. She often said that one of her primary tasks was to help her clients learn to say yes when they meant yes, and no when they meant no.

Those who work in the growing field of addiction recovery, especially recovery from codependence, emphasize the need for personal integrity—that is, honesty with yourself and others. Virginia Satir estimated that codependence afflicts over 90 percent of the U.S. population. "The disease of lost selfhood," as author Charles Whitfield, MD, calls codependency, is probably at the root of all other addictions. It results from focusing too much on what is outside of yourself and thereby depending on others to define what you think, how you feel, and what you do.

The High Cost of Yes
While an attitude of openness to life is definitely health-promoting, saying yes to life means saying no a good deal of the time, too. People who are afraid of disapproval from others will say yes regardless of their true feelings to avoid rocking the boat. The question can range from the trivial ("Would you like a cup of coffee?") to the serious ("Can I stay at your apartment for a few weeks?"). When it comes to dealing with doctors or other caregivers, it is easy to fall into the trap of being a passive patient, afraid to say no to a suggested procedure, for instance, even though you may feel very ambivalent about it.

There is a high price to pay for such a lack of honesty in your personal relationships and in your dealings with professionals. Here’s why:

• It’s stressful. Holding in feelings of anger or frustration while smiling and saying yes causes unnecessary tension, and if you do this continually it may erupt in physical symptoms or emotional confusion and instability.
• It’s confusing. Other people will read the true message in your body language, tone of voice, or energy level. They will be unsure of what you are really saying and will question your trustworthiness.
• It undermines yourself. You erode your own self-esteem when you deny that you have insight, opinions, intuitions, and value judgments. By saying yes when you mean no, you give up your vote over what goes on in your own life. The more you deny yourself, the more you may feed feelings of low self-worth and set in motion the cycle of dishonesty/guilt/self-hatred/depression.
• It disempowers others. When you assume that other people will be upset or fall apart because you say no, you are assuming they do not have the strength to hold on to their own convictions. Genuine friendship or colleagueship cannot grow from such a weak foundation. Loneliness is often the result.

Learning to Say No
Admittedly, saying no is not easy if a lifetime of ambivalent yes-saying has preceded it. You may find that you are suddenly less popular with certain people (especially those who are afraid to think for themselves). Keep in mind that the practice of saying no does not imply being nasty, cold, or arrogant toward others. No is just no. It can still be said in a way that respects the other.