Why Assholes May Live Longer

Lissa Rankin, MD
8 min readMay 19


Right now, I’m sitting on the South Aegean Sea in Kos, Greece, where I was invited to help a group of German doctors renew their Hippocratic Oaths at the Asklepieion temple where Hippocrates, the father of modern medicine, started a famous healing temple and his famous medical school around 400 BC. On Tuesday, we’ll be witnessing a reenactment of the first medical school graduation and participating in our own sacred ritual of renewal, based on the ideas Hippocrates of Kos first espoused and allegedly wrote about in books like On The Sacred Disease, one of the first treatises that tried to separate the origin of disease from the prevailing notion that disease was the result of some sort of spiritual curse, a notion that still gets espoused by religions like Christian Science and New Age ideas like the law of attraction.

I do think it’s unwise to separate science and spirituality with the rigor of Descartes mind-body split, as I wrote about extensively in both Mind Over Medicine and Sacred Medicine. But I agree with Hippocrates that shaming sick people by suggesting there’s something wrong with them spiritually does everyone a disservice.

All that I’ve been reading in preparation for my pilgrimage to the temple of Asklepieion has led me to reflect on all the decades I’ve been pondering what really makes us vulnerable to premature disease and what really helps us get well when we’re chronically ill. After working with thousands of patients and clients and physicians over the years, it seems that, so often, at least part of the problem seems to revolve around wounded boundaries that prevent us from being able to stand up for ourselves and our optimal health and cause us to tolerate mistreatment, often in the name of being a “good” or “nice” or “spiritual” or “unconditionally loving” person. While there’s definitely a place for spiritual healing in my world view, it’s like spirituality and protecting one’s self and one’s health from people who want to cross your boundaries have gotten all mixed up in all the wrong ways.

When I gave my keynote at the congress for the International Society for Natural and Cultural Medicine in Greece this week, I shared with the audience my unscientific and demoralizing conclusion that assholes seem to live longer than “nice” people. The people who are inflicted young with cancer, autoimmune diseases, disabling neurological conditions, chronic pain syndromes, and other devastating illnesses that prevent someone’s health span from equalling their life span- or shorten the life span tragically- often seem to be the kindest, most generous, good-hearted, amiable, compliant, easy-going, friendly, considerate, people-pleasing, lovable individuals. Meanwhile, the crotchety old jerks who feel entitled to cross the boundaries of others but know how to protect their own boundaries seem to keep on ticking well into their nineties.

What a disappointment to realize that, after 15 years of research, a disillusioned part of me kind of has to agree with an article from the British satirical parody The Daily Mash, which reports:

“The secret to living a long, happy life is to be nasty, unintelligent or a combination of the two, research has found. Studies have shown that expending energy on a high-functioning brain or exercising a social conscience can take as much as 20 years off a lifespan. By contrast, those who rarely engage their cerebral cortex and are unfailingly hateful to their fellow man frequently live into their 90s or beyond. Professor Henry Brubaker, of the Institute for Studies, said: “Whether a central African dictator or Rupert Murdoch, we see time and again a clear link between longevity and being an absolute, unflinching bastard.” Empathy and philosophizing are all very well, but it seems both heart and brain are best preserved by using them the absolute minimum possible. Naturally, diet and exercise are also factors but we recommend that everyone try to be an utter fucker at least three times a week, ideally building to 60 minutes every day.”

While obviously tongue in cheek, there’s actually some scientific data to suggest that the satire is based on at least a modicum of truth. For example, we initially thought that anger might increase the risk of fatal heart disease. But this study of people with coronary heart disease showed the opposite. People who express their anger lived longer than those who suppressed it. By contrast, the Longevity Project study conducted by Friedman & Martin found that nice, pleasant cheeriness is a risk factor for early death, which is consistent with the writings of physicians like Gabor Mate ( When The Body Says No) and Bessel Van Der Kolk ( The Body Keeps The Score.)

Part of these findings may revolve around redefining what it means to be a psychologically and spiritually healthy individual. What if it’s not healthy or spiritual or wise or compassionate to throw yourself under the bus or self-sacrifice and martyr yourself for people who have no intention of doing the same for you? What if protecting yourself and your loved ones from people who might wish to prey upon your niceness and generosity predatorily is not selfish; it’s self-loving and health-inducing?

Our families and cultures may indoctrinate us into believing that a good or generous or loving or spiritual person is an easy going, compliant, pleasing, cheerful person who never shows signs of anger. Yet, it turns out that this personality style is not particularly good for long term health or self-protection. What’s so spiritual about not protecting yourself- in a healthy way- from exploitation, predation, or being taken advantage of by people who aren’t particularly concerned about your wellbeing, longevity, or psychological or physical health?

I’m not suggesting we should all become asshats so we can live longer. But perhaps we’d be better off being less “nice” and more boundaried, less pleasing and more self-protective. Maybe there’s something we can do proactively to enjoy the health benefits of the assholes while retaining our good nature and lovability. Perhaps it behooves us to be less accommodating to others, especially entitled, demanding people who take advantage of our niceness, and more accommodating of the needs of our own parts inside. For some of us who have had our thinking twisted up by religion and spirituality, this may turning everything we believe on its head, flipping our ideas of what real compassion requires, and opening ourselves to a new way of thinking, one that values self-compassion and self-protection, which then allows us to extend compassion and protection of the vulnerable outwards, without martyrdom.

I’m not suggesting that there’s never a role for risking one’s own protection in order to protect someone else. As I write this, I’m watching little children swimming in the Aegean Sea, which is kind of choppy today. If one of them started screaming for help, I might actually jump in the ocean to try to save a young life, even if it put mine at risk. Many activists fighting for human rights take risks every day because they care so much about making the world a more just place. Many people that I know are willing to take those kinds of risks- and that’s a noble impulse. But that doesn’t mean we should martyr ourselves for people who are blended with narcissistic, sociopathic, power hungry, predatory, ruthless parts and are not in treatment for those traumatized parts, people who have no concern for our wellbeing and make the same sacrifices for us if we needed help.

While I look at Turkey right across the sea, only 4km away, I’m preparing to teach an online class Becoming Unf*ckwithable, about finding your sacred “no” so your yes is a “hell yeah.”

You can sign up for Becoming Unf*ckwithable here.

This online program is not about becoming an asshole so you can live twenty years longer. It’s about preparing to stop taking crap from those who might threaten to drain your life force, impact your health, harm your financial security, cause you to risk your own protection, and damage your psychological stability. What’s the point of continuing to accommodate people who don’t care about how over-caregiving or neurotic tolerance of being mistreated or allowing yourself to be narcissistic supply for predatory people who drain your life force in order to increase their own could make you sick? Given that this kind of trauma-induced fawning, over-accommodating behavior has been linked to early onset disease and disability and a shorter life span, wouldn’t it be worthwhile to consider flipping the way you relate to such people as part of your preventive medicine strategy or as part of treatment for chronic or life-threatening illness?

I’m here in Greece with my partner Jeffrey Rediger, MD, MDiv, who went to seminary at Princeton, is a medical school professor at Harvard and the medical director of Harvard’s inpatient psychiatric hospital McLean Hospital, and spent 17 years researching “health outliers” who were cured from allegedly “incurable” illnesses, the results of which he published in his book Cured. He also spoke at the conference here, and one of the stories he told in an interview with a German journalist yesterday was how one of the reliable common denominators he discovered among the radical remission survivors he researched was that many of them underwent a complete personality change.

When given 6 months to live, for example, some of them decided that if they’re dying anyway, why the hell were they still tolerating the verbal abuse of their controlling mother in law? If their mortality was right around the corner, why weren’t they standing up for themselves at work when their narcissistic boss ordered them around with no concern for their feelings or wellbeing? If it was about to be over, why were they still tolerating their toxic spouse or their abusive sibling or their entitled addict child? Jeff says that some of these sick folks went from doormats to “selfish bitch” or “selfish dude.” They got feisty, quit taking everyone’s shit, stood up for themselves, and started feeling entitled- in a healthy way — to being treated better by others.

Jeff was partially kidding, but I challenged his language and lovingly poked at his own conditioning around what it means to care for the self. What’s selfish, I asked him, about taking care of your hurt parts and protecting your boundaries, your health, your bandwidth, your safety, your emotional wellbeing, your bank account, your creativity, your inner child, or the free flow of your life force? Why should we wait for a life-threatening diagnosis or a death sentence to get a little bit feisty? What makes us think other people can’t handle feeling a little bit disappointed that we’re not 100% at their beck and call, compulsively and addictively accommodating their needs while suppressing our own and thinking it’s noble or spiritual to do so? We need to change how we talk and think about such things. Protecting yourself is not selfish, and relentlessly martyring yourself is not noble; it’s masochistic. You don’t need to get sick in order to flip the script on this kind of indoctrination.

Do you agree- or do you feel resistance to what I’m writing here? You’re always welcome to respectfully challenge what I say, push back, and express your own point of view here. I’d love to hear your thoughts and feelings about this topic. Please send me an email to support@lissarankin.com



Lissa Rankin, MD

Lissa Rankin, MD, New York Times bestselling author of Mind Over Medicine, The Fear Cure, and The Anatomy of a Calling.