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People who can't say no risk stress, anger and even illness

It might be the easiest word to say, and the most overused in our culture.

Help out with the school's bake sale? Yes. Work an extra shift at the hospital? Yes. Bring a main dish to the neighborhood dinner party after your 60-hour workweek? Yes.

"Yes" might be the automatic, simplest or least painful response — even when we truly want to say no. But there is eventually a price: in stress, anger, passive-aggressive behavior, exhaustion and illness.

Oprah Winfrey refers to the syndrome as "The Disease to Please," a 2002 book by the late Harriet Braiker (McGraw-Hill).

So who has this disease, and how did they get it?

"The need to please is instilled in us from an early age when we learn to 'be nice,' " says New Jersey-based psychologist Patricia Farrell. "Women in particular are reminded that it's not nice to say no, unless it's in the context of a sexual request."

Farrell, author of "How to Be Your Own Therapist" (McGraw-Hill), devotes a chapter to the practice called "Stick Up for Yourself," in which she tells readers how to avoid the doormat syndrome. "That's where everyone else's wishes are more important than yours," she says.

Psychologists say that while women have been trained to say yes to others' needs at their own expense — or risk being condemned as selfish — men can face the same problem, though there are some differences.

John Townsend, a California-based therapist and co-author of the classic self-help book "Boundaries" (Zondervan), says that while women do more people-pleasing in relationships, men are more likely to say yes to tasks.

"They might lend their lawn mower to a neighbor even though they don't like him, or they'll say yes to extra responsibilities at work," Townsend says. Men will try to fix a problem even if they don't have the time, energy or knowledge to do it, he says.

Or they always might be the one to help out their overly demanding parents, even as their own wife and children get short shrift. That's particularly unhealthy, Townsend says, "because a clear marker of adulthood is that you leave your family of origin, and the family you create has to come first."

Why is it that men and women can't say no — whether to onerous tasks or to enjoyable activities they just don't have time for? Townsend says the reasons fall into a few categories of fears:

• A fear that we will lose a relationship with the person who is asking us for something if we don't say yes. "As humans, we are relational creatures, so this can be difficult for us," Townsend says.

• A fear of someone's anger. "Most of us want to avoid conflict, so we will give in, not realizing that we are training the person to treat us this way in the future, by them threatening to get mad at us," he says.

• A fear of hurting people. "This causes more damage than you would think, because we are not treating the person like an adult," Townsend says. So we end up getting angry or resentful, or show by our attitude that we really didn't want to say yes.

The empowerment of "no"

Sometimes people say yes merely to get rid of the questioner with no intention of doing what they agreed to.

In the popular book "The Four Agreements" (Amber-Allen Publishing), author Don Miguel Ruiz addresses this issue in the agreement that states, "Be impeccable with your word."

Ed Fox is a San Diego-based life coach who studied with Ruiz and frequently lectures on "The Four Agreements." He explains that the principle means, "We do what we say we are going to do." Which, by extension, means not saying yes lightly.

"But it also goes deeper than that," Fox says. "Say that you said yes to going out on a date with someone even though you didn't want to. Then you need to ask yourself: What beliefs do I have about relationships, or about myself in relationships? Why can't I say no, or why do I not feel I have the right to say no?"

Fox maintains that change isn't as easy as just starting to say no.

"What you have to do is start listening to yourself and begin breaking the old structures of just reacting the way you've been programmed to," he says. "Eventually there will be a shift, and it gets changed to action, and then you will feel empowered to say no."