Affirming Life: Rethinking Health with Nietzsche
Friedrich Nietzsche is a thinker I approach with ambivalence. On a personal level, I find little to admire in the man. His life was marked by isolation, instability, and a troubling disdain for compassion. While undeniably influential, his works are complex to the point of opacity and rife with ideas that range from the unconventional to the outright dangerous.
And yet, despite my reservations about the man and his philosophy as a whole, I find myself compelled by Nietzsche's ability to overturn conventional thinking — to take assumptions and turn them upside down and inside out until we are forced to see them in a strange, unsettling new light. It is in this spirit that I want to explore one of his most insightful ideas — his radical rethinking of health:
“Health and sickness are not essentially different, as the ancient physicians and some practitioners even today suppose. One must not make of them distinct principles or entities that fight over the living organism and turn it into their arena. That is silly nonsense and chatter that is no good any longer.”
Nietzsche directly challenges the traditional dichotomy between health and sickness. He suggests that they are not fundamentally different states but exist on a continuum. Further, Nietzsche distinguishes between two concepts of health. The first is most familiar—a health defined primarily by negation, by what it seeks to avoid rather than what it affirms. We might liken this version of health to a fortress mentality, where the body is seen as a stronghold under constant siege. Here, health becomes an anxious state of watchfulness, a never-ending battle against illness, decline, and mortality.
Viewed this way, every symptom is a hostile invader that needs to be quickly suppressed, and every risk factor a dangerous vulnerability that must be eliminated. The doctor is the commander, marshaling an arsenal of tests, drugs, and procedures to fend off the relentless onslaught of pathology.
But for all its efforts, this fortress of health is ultimately a life-denying, soul-shrinking stance toward our existence. It is a posture of defense and reactivity, a timid and constrictive way of engaging with the inescapable reality of our vulnerable, mortal condition. In seeking to ward off suffering and decline at all costs, it encloses us in a fearful relationship with our own bodies and the world around us, cutting us off from meaning, creativity, and growth.
But Nietzsche doesn't stop at critique. He offers a different vision of health that doesn't seek to avoid suffering at all costs but embraces it as an inevitable and even essential part of the human experience. This affirmative health says "yes" to existence in all its complexity and contradiction, its beauty and its horror. As Nietzsche puts it:
A typically morbid being cannot grow healthy, still less be made healthy; for a typically healthy person, alternatively, an illness can even be an energetic stimulant for living, for living more. [… The well-developed person] guesses the cure for impairments; he exploits bad accidents for his own advantage; what does not kill him, makes him stronger.
In this inversion, true health is not the absence of sickness but the capacity to grow through suffering. For the resilient individual, even an illness or injury can spur greater vitality and self-overcoming, an opportunity to turn adversity into advantage, poison into medicine.
This perspective seems strange and even troubling at first, but the more I consider it, the more I appreciate it. While modern medicine has undoubtedly led to miraculous advances in diagnosing, treating, and preventing disease, in our enthusiasm for science and immortality, we may have lost sight of the bigger picture of what health truly means.
To be clear, I'm not advocating for an abandonment of medical science in favor of a Dionysian frenzy. Nor am I glorifying pain and illness as desirable in themselves, as if the more we hurt, the more enlightened we become. There is no question that modern medical science plays an essential role in alleviating suffering, curing disease, and extending life. These achievements have improved the human condition, and we should continue to celebrate and pursue science with all the creativity we can muster.
Yet Nietzsche's critique invites us to question whether, in our scramble to evade suffering, we neglect the cultivation of a deeper vitality—the richness that makes life worth living.
Take, for instance, our society's escalating dependence on pharmaceutical interventions. The statistics are staggering: despite having only 5% of the world's population, the United States consumes a whopping 80% of the global opioid supply. Equally troubling, one out of every six Americans is currently taking some form of psychiatric medication.
I worry that our medical system has become overly focused on pharmacological quick fixes, turning to pills to manage every discomfort or distress. In our quest to fine-tune our biochemistry, we risk losing sight of the holistic factors that shape our well-being—our lifestyles, habits, and environments. By outsourcing the regulation of our inner states, we may be eroding our capacities for resilience and self-regulation.
Moreover, the interventions of modern medicine, for all their benefits, come with a disturbing dark side: the risk of iatrogenic harm.
A Johns Hopkins study found that medical errors are the third leading cause of death in the US, behind only heart disease and cancer. Adverse side effects, unnecessary surgeries, hospital-acquired infections, and other complications underscore the risks of an overly interventionist approach that too often loses sight of the fundamental dictum to "first, do no harm."
Then, there's the crucial distinction between lifespan and health span. Modern medicine is fixated on extending life—keeping hearts beating and lungs breathing for as long as possible. But we must ask a fundamental question: What kind of life are we prolonging? Are we merely adding years to a life of frailty, pain, and cognitive decline? Or are we enhancing the quality of the years we have, the vitality and meaning we can wring from our brief time on earth?
In our quest to stave off death, we risk overlooking that there may be fates worse than a dignified ending — such as being trapped in a broken body, a perpetual fog of confusion, or an unrelenting torment of agony. We forget that sometimes, the greatest act of compassion and respect for life is to allow it to end gracefully. Nietzsche challenges us to consider what it truly means to live, not just to live long:
“The more one seeks to preserve life merely for the sake of life and the less life is connected to some significant ideal content, the unhealthier it usually becomes, the more it manifests its contradiction to the principle from which life draws its deepest health — the principle that life needs to be risked in order to be preserved in a higher sense.”
Finally, I'm both awed and troubled by modern medicine's hyper-specialization. On one hand, the depth of expertise that specialists bring to bodily systems and specific disorders has led to remarkable advances. Our understanding of the workings of the human body has never been more sophisticated. Yet, I can't shake the concern that in our enthusiasm to master the microdetails, we lose sight of the macro — the interconnectedness of the human organism. By fragmenting the body into discrete parts, each managed by its expert, we create a medical culture that treats patients like malfunctioning machines instead of integrated wholes.
What would it mean to embrace health as a dynamic process of adaptation, resilience, and growth in the face of life's challenges? To see our finitude and vulnerability not as shameful weaknesses but as aspects of our humanity to be celebrated?
This would require us to abandon the illusion of total control, the fantasy that through enough interventions, we can transcend the fundamental realities of embodied existence. It would mean learning to find meaning, purpose, and even beauty in the very limitations and uncertainties that define our mortal condition.
Practically, this might mean greater emphasis on preventative care and lifestyle interventions. Rather than defaulting to pharma, physicians would engage in understanding the full context of each patient—their stressors, habits, relationships, and sources of meaning. The clinical encounter would become a space for collaboration, where doctor and patient work together to cultivate the skills, practices, and mindsets that promote authentic thriving. This might involve in-depth conversations about nutrition and physical activity but also about stress management, social connections, and nurturing a sense of purpose and engagement with life.
The goal would be to empower patients to become active agents in their own flourishing, equipped with self-understanding and tools to navigate life with energy.
Treatment would still have an important place, but it would be oriented around supporting the body's healing capacities rather than suppressing symptoms. There would be a greater openness to integrative approaches that honor the wisdom of traditional healing while leveraging the best of modern science. This synthesis would yield an approach that is at once evidence-based and attuned to the multidimensional nature of healing.
This lofty vision would require a profound transformation not just of our healthcare institutions and practices but of our cultural attitudes towards health and embodiment. It would require us to question our assumptions about what it means to live, to suffer, to heal, and to die. At the level of our healthcare system, it would necessitate a reimagining of the roles, relationships, and power dynamics between patients, providers, and communities. But more importantly, it would require us, as individuals, to confront the realities of our existence with a new level of honesty, courage, and compassion.
None of this would be easy. Established interests would resist any shift that threatens their bottom line. Policymakers, mired in short-term thinking and beholden to lobbyists, may lack the vision and courage to enact the necessary changes. Even some patients, comfortable with the familiar paradigm of quick fixes and magic bullets, might balk at the prospect of such a radical reorientation.
And yet, for all the challenges and resistances, there is a case to be made that such a transformation is not only possible but urgently necessary. In a world increasingly burdened by chronic disease, mental illness, and a pervasive sense of alienation and disconnection from our own bodies and lives, the limitations of our current view are becoming more apparent.
Ultimately, the question is not whether such a transformation is possible but whether we have the courage and imagination to pursue it. The obstacles are real, but so is the opportunity — the chance to create a world in which the experience of being human is not a burden to be endured but a gift to be celebrated in all its fullness.
