How to be a Bitch (and why it matters)

The art of disappointing people without abandoning yourself.

TL;DR:According to Gabor Maté, if you're not a bitch, you might get an autoimmune disease. Whether or not that's true, his provocation raises an important question: what happens when we become so organised around other people's needs that we lose contact with our own? A reflection on self-sacrifice, belonging, boundaries, creativity, and the cost of abandoning ourselves in order to keep everyone else comfortable.

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At a conference recently I heard Gabor Maté say:

"If you're not a bitch, you'll get an autoimmune disease."

I laughed, then found myself unable to stop thinking about it.

What Maté means by "bitch" is not someone who is cruel, demanding, or difficult. Quite the opposite. He is referring to the capacity to be appropriately self-protective: to recognise your own needs, express healthy anger when boundaries are crossed, tolerate disapproval, and say no when something is not right for you.

Over many years, he has observed that people living with autoimmune conditions often share certain characteristics: difficulty saying no, the suppression of healthy anger, a strong sense of responsibility for others, and a tendency towards self-sacrifice.

His suggestion is that there may be a cost to living this way.

What caught my attention was the question beneath that provocation, one that has shaped much of my work as a therapist and, if I'm honest, much of my own life too: what is the cost of organising your life around other people's needs?

When I read through Maté's list, it is hard not to feel a flicker of recognition.

Not because these are pathological qualities. In fact, many of them are actively rewarded. We admire people for being generous, dependable, accommodating, selfless, and endlessly willing to help.

Yet Maté invites us to consider what happens when these qualities become habitual, automatic, and one-sided.

While I find his observations compelling, I find myself looking at these patterns through a slightly different lens.

Creative Adjustments

There is another way to understand these patterns: not as pathology, but as creative adjustments, often learned in childhood — intelligent, often necessary ways of adapting to the circumstances in which we find ourselves. A child who learns to suppress anger, anticipate the needs of others, avoid conflict, or become hyper-responsible is not displaying a flaw in their personality. They are finding a way to survive, belong, and maintain connection within the perhaps somewhat unpredictable world they inhabit. Which is, if you think about it, a fairly heroic skill set for someone who can’t yet reach the kitchen counter.

The problem comes when an adaptation that was once flexible becomes fixed. Instead of choosing when to accommodate, we accommodate automatically. The adaptation no longer serves us; we begin serving it. The cost is not only emotional. Over time, these adaptations can also narrow our capacity to respond creatively to life.

The question, then, is not whether we sacrifice ourselves from time to time. The question is whether we know how to stop.

For me, this isn't simply a theoretical question.

Learning to Organise Around Others

I grew up in a family where emotional stability often felt uncertain. My father's temper could be unpredictable and surprisingly easy to trigger. He wasn't violent, but the emotional climate of the house could shift quickly. My mother lived with bipolar disorder and was often emotionally fragile, her moods fluctuating dramatically, sometimes accompanied by suicidal thoughts and attempts.

Looking back, I can see how much of my attention became organised around other people. I learned to respond quickly to my father's demands before frustration had a chance to escalate. I learned to be careful with my mother's feelings, often withholding my own needs in an effort to protect her fragility. I can still remember the quiet calculations that often happened before I spoke: What mood is he in? How is she today? Is now a good moment, or should I wait? Without ever consciously deciding to, I became skilled at reading the room, anticipating emotional weather, and adjusting myself accordingly.

The difficulty is that adaptations have a habit of outliving the circumstances that created them.

I can see how that early vigilance followed me into adulthood. I became fluent in the language of other people's moods. I could sense tension almost immediately and often tell when somebody was upset before they had spoken a word. My attention was instinctively drawn towards the needs and feelings of those around me. What I found much harder was answering a far simpler question: What do I want right now?

When you spend enough years tracking other people's emotional weather, you can lose contact with your own.

That sensitivity has undoubtedly served me well. It helps me attune to clients, build relationships, and navigate complex interpersonal situations. Yet it can also come at a cost.

One place I notice this most clearly is in the therapy room. When a client's anger is directed towards me, I sometimes become aware of an old impulse to smooth things over, explain myself, or move away from the discomfort. The work, for me, is not to eliminate that reaction but to recognise it for what it is: a creative adjustment that once served me well and may no longer be needed in quite the same way.

Beneath self-sacrifice, I often find something else entirely. The people I meet in therapy are rarely making conscious decisions to place everyone else's needs above their own. More often, they have become organised around it. What began as an adaptation has become so familiar that it no longer feels like a choice at all. 

Children are remarkably inventive in the ways they learn to belong. A child quickly discovers that some expressions of themselves attract connection and approval, while others risk criticism, rejection, conflict, or shame. So they adjust.

These adaptations work so well that we forget we ever made them. The challenge is that what helps us belong as children can limit us as adults.

The same pattern has shaped parts of my own life, but it is not simply a family story. As I explored in The Double Standard of No, our culture often treats boundaries differently depending on who is expressing them. Women, in particular, are frequently expected to be endlessly accommodating and can find themselves judged harshly when they assert their needs. It is no coincidence, perhaps, that Maté chose the word bitch. In many contexts, "bitch" is precisely the label applied to a woman whose boundaries are no longer organised around keeping other people comfortable.

At some point, the capacity to care for others has to be accompanied by the capacity to remain in contact with ourselves. Otherwise our attention becomes so focused on the needs, expectations, and feelings of other people that we gradually lose sight of our own.

The Cost of Adapting

Whether these adaptations contribute to autoimmune disease remains an open question. What interests me is a different question: what happens when our needs, feelings, desires, and boundaries are repeatedly pushed out of awareness?

In an earlier piece, I wrote about what I came to think of as quietly quitting my own marriage. Rather than risking conflict or insisting that my needs be addressed, I adapted. I accommodated. I convinced myself that enduring was the same thing as coping.

For a long time, it seemed to work.

Until it didn't.

What I couldn't see at the time was how little room remained for me inside a life that looked functional from the outside. Looking back, there was a growing heaviness to life that I simply accepted as normal.

Eventually the cost of that adaptation became impossible to ignore, culminating in a three-month stay in a psychiatric ward.

Looking back, I don’t see weakness. I see the inevitable consequence of spending years organising myself around preserving a relationship while gradually losing contact with myself.

In that same essay, I reflected on Monica Corcoran Harel's piece in The Cut. One woman, exhausted by a broken 20-year marriage, came to understand her Parkinson's diagnosis through the lens of that stress. Whatever the medical reality, the meaning she made of it is striking. She wrote: "I believe, with all of my being, that I got my diagnosis from the stress of lying to myself and pretending we had the perfect marriage and family."

Again and again, I meet people whose anxiety, burnout, depression, chronic tension, or sense of deadness seem connected to a lifetime of overriding themselves. Not because they are weak or broken, but because they have become so practised at adapting that they no longer know where adaptation ends and they begin.

I would love to be able to write about this as though I have somehow graduated beyond it. Unfortunately, life keeps providing opportunities to practice.

Recently, I found myself staring at a text message that I didn't want to send. Someone had asked me for something that I genuinely didn't have the capacity to give. I was tired, my diary was already full, and a quieter part of me knew the answer was no. Even so, I could feel my body preparing for impact: a slight tightening in my chest, a knot in my stomach, as though a simple boundary carried the threat of something much larger. And yet I sat there for the better part of twenty minutes composing increasingly elaborate alternatives.

Could I do it another day? Could I offer something else instead? Could I make the no sound a little less like a no? I appeared to be negotiating a peace treaty rather than declining a favour.

What struck me was how little attention I was paying to my own experience. The reality was straightforward: I didn't have the capacity. Yet my mind seemed far more interested in imagining their disappointment than acknowledging my own limits.

By the time I eventually sent a perfectly reasonable message declining the request, I felt as though I had narrowly avoided a minor diplomatic incident.

The response arrived a few minutes later.

"No worries at all."

That was it.

No anger. No rejection. No collapse of the relationship. Just a brief acknowledgement from someone who appeared entirely capable of tolerating a boundary that I had spent twenty minutes convincing myself might be catastrophic.

It’s a pattern I know well. Somewhere inside me there remains a part that still believes saying no is dangerous. A part that assumes another person’s disappointment is a problem that needs solving rather than an ordinary part of being in relationship. What I’m slowly learning is that other people’s disappointment is not the same as damage — and that tolerating it, without collapsing into apology or explanation, might be one of the quieter forms of self-respect.

Not becoming harder. Not becoming less caring. Simply becoming willing to tolerate the possibility that someone else may not get what they want, without immediately abandoning yourself in the process.

Creativity and the Loss of Self

Not long ago I sat down to write something new. Within minutes I noticed my attention had quietly migrated. I wasn't asking what do I want to say? I was asking what will they think of this? Will it land? Will someone be disappointed, or worse, unimpressed? I had been at my desk for half an hour and produced three sentences, each one written for an imagined audience I couldn't even see. I wasn't creating. I was managing. Three sentences in thirty minutes is not a writing practice. It’s a hostage negotiation with myself.

What fascinates me is that the same adaptations that disconnect us from anger often disconnect us from creativity. Both require something similar: the willingness to feel what we actually feel, to want what we actually want, and to risk the discomfort of expressing it. When we learn to override one, we tend to override the other too.

And I don't mean creativity as artistic talent.

I mean creativity as aliveness. The capacity to respond freshly to life rather than automatically. The willingness to experiment, take risks, and step beyond familiar roles. The ability to surprise ourselves.

If my attention is constantly directed towards everyone else's needs, expectations, moods, and reactions, how much is left for curiosity? For spontaneity? For discovering what I want, what I think, what I feel, and who I might become?

Creativity requires contact with ourselves. It requires access to our own experience, desires, impulses, and imagination. Yet many of us have become so skilled at monitoring the emotional world around us that we barely notice our own. It's remarkably difficult to create anything fresh when you're busy trying to anticipate how everybody else might respond to it.

When we become overly identified with who we think we should be, we lose contact with who we actually are.

The compliant self can survive very effectively, but it struggles to create. It struggles to experiment. It struggles to step beyond the boundaries of what is already known.

Perhaps this is how these adaptations persist. A present-day encounter brushes against an old story and suddenly the past feels alive again. 

Perhaps this is what Maté was pointing towards.

Not that being nice causes illness. But that organising our lives around other people's needs comes at a cost. The cost of saying yes when we mean no. The cost of swallowing anger when it needs expression. The cost of prioritising belonging over authenticity. The cost of becoming so preoccupied with who we need to be for everyone else that we lose contact with who we are.

For most of my life I was an expert in other people's weather. I could feel a change in the atmosphere before a word was spoken. What I'm slowly learning, later than I'd like, is how to notice my own.

Which leaves me wondering whether this was never really about being a bitch at all.

Perhaps the question is not whether you are hard enough, defended enough, or willing enough to disappoint. Perhaps it is something quieter: who did you become in order to belong? And what has it cost you to remain that person?