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Blackwell Publishing LtdOxford, UKNUPNursing Philosophy1466-7681Blackwell Publishing Ltd 2006

20067?3748

Original Article

The Will to Health

Clinton E. Betts

Correspondence: Clinton E. Betts, Assistant Professor, School
of Nursing, Faculty of Health Sciences, McMaster University,
1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.
Tel.:

+

905 525 9140 Ext. 22036; fax:

+

905 570 0667; e-mail:
bettsc@mcmaster.ca

O
r
i
g
i
n
a
l

a
r
t
i
c
l
e
The will to health: a Nietzschean critique

Clinton E. Betts

BSc BScN MEd RN

Assistant Professor (P/T), School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Abstract

The purpose of this paper is to propose a critique of the prevailing
attitude of human health, what I refer to as

the will to health

, using a
Nietzschean perspective. First, I briey discuss the purpose and manner
of Nietzsches methodological approach to philosophy and his problem
with modernity. Second, I explicate the two current ideological para-
digms of health that, in my view, constitute the prevailing will to health.
Third, Nietzsches general understanding of human health is presented
and following this, a critique of some contemporary health matters from
this perspective is undertaken. Strictly speaking, there is no specic
thesis to be found in this paper. I do not presume to prove or disprove
anything, rather I avail myself of Nietzsches unique insight into the
human condition as a rubric from which to illuminate something of the
nature of human health.

Keywords:

philosophy, Nietzsche, rationalism, health, scientic

progress.

Introduction

It is surely a platitude to propose that the very exist-
ence and fundamental aspiration of nursing is the
furtherance of human health. It would seem then to
follow that, any and all theoretical labours concerning
nursing must also have this as a seminal objective. To
this end, a great deal of effort has been put forth by
nursing theorists over that past few decades towards
the usurpation of existential philosophy as an under-
gird for the understanding and conceptualization of
nursing. In addition, nursing writers have also appro-
priated a good deal of phenomenological and post-
modern thought. The work of theoretical nursing has
often relied heavily on that of Martin Heidegger,
although others (e.g. Sartre, Husserl, Foucault, Mer-
leau Ponty, to name just a few) have certainly gured
prominently.
Yet, it is interesting to note that the universally
acknowledged progenitor of such thinking, Friedrich
Nietzsche, has been given far less attention. The pau-
city of reference in nursing and health theory litera-
ture to Nietzsche might well be understandable given:
(a) his association with authoritarianism (in particu-
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lar that of Nazi Germany); and (b) the nature and
degree of his philosophical provocation; specically
his apparent and protracted emphasis on strength and
power.
Scholars over the latter half of the 20th century,
Walter Kaufman and R. J. Hollingdale preeminently,
have contended that in these matters Nietzsche has
been misunderstood and indeed intentionally cor-
rupted by a number of individuals following his
death. However, Nietzsche still remains a philoso-
pher of great complexity and controversy. The
debates concerning Nietzsches thought and its
extreme nature still continue to rage, virtually
unabated, leading Murphy (1984) to conclude that
. . . there can be no denitive interpretation of
Nietzsche . . . (p. 2). Still we should not be timid
about the pursuit of a Nietzschean critique as not only
germane to human health, but undeniably vital to our
understanding of the human predicament in the con-
temporary world. For Nietzsche, the very dening
ambition of philosophical pursuit was human health.
The purpose of this paper is to propose a critique
of the prevailing attitude of human health, what I
refer to as

the will to health

, using a Nietzschean per-
spective. First, I shall briey discuss something of the
purpose and manner of his methodological approach
to philosophy. Second, I will explicate the two current
ideological paradigms of health that, in my view, con-
stitute the prevailing will to health. Third, Nietzsches
general understanding of human health will be pre-
sented. Following this, a critique of some contem-
porary health matters from this perspective is
undertaken. Strictly speaking, there is no specic
thesis to be found in this paper. I do not presume
to prove or disprove anything. It is not my purpose
to contend that Nietzsche was correct, but rather to
avail myself of his unique insight into the human
condition as a rubric from which to illuminate some-
thing of the nature of human health.
Indeed, the important debate that is currently
being advanced in the philosophy literature concern-
ing human health and its proper conceptualization by
such pundits as William Fulford, Christopher Boorse,
Jerome Wakeeld, and Lennart Nordenfelt among
others is herein ignored. Finally, although I certainly
recognize the potential for controversy inherent in a
polemic such as this, as with anything associated with
Nietzsche, perhaps one should expect nothing less.

Prefacing Nietzsche

A careful reader of Nietzsche will likely recognize at
least three major aims of his work. A commitment to
uncompromising honesty in his examination of
human existence, a fervent passion in the afrmation
of life, and nally a deep and inspiring concern for
the welfare of human beings. No doubt, some will nd
this last conclusion rather odd given Nietzsches
incessant evocation of power, strength, cruelty, and
suffering as veritable human necessities. However,
the issues of content in Nietzsche are often inextrica-
bly bound up with his style. As numerous commenta-
tors have asserted the style and manner in which
Nietzsche expressed his ideas were by design and
moreover were intended to convey a message in itself
(Nehamas, 1985). Nietzsche had an almost patholog-
ical weakness for one particular kind of ambiguity . . .
to lead astray hasty readers, browsers, and that rap-
idly growing curse of our time the non-readers who
do not realize that galloping consumption is a disease
. . . (Kaufman, 1989, pp. 67).
There is though, quite possibly, another reason why
Nietzsches style is such a demanding affair. In refer-
ence to such an imperative element of Nietzsche, I am
reminded of Kierkegaard. It occurred to [Kierkeg-
aard] then that since everyone was engaged every-
where in making things easy, perhaps someone might
be needed to make things hard again . . . (Barrett,
1962, p. 157). Hence, in a similar manner as Kierkeg-
aard, the very rst thing that Nietzsche does for the
reader though perhaps to the reader is more appro-
priate is level serious scrutiny at virtually all of the
foundational assumptions of Western thought. Yet, it
would be quite erroneous to label Nietzsche a vile
malcontent, or even uncaring for that matter, as
regards the human condition.
In many of his letters, which were not intended for
publication, we often glimpse a rather sensitive dis-
position towards the predicament of human beings.
Even now my whole philosophy wavers after an
hours conversation with a total stranger. It seems so
silly to want to be right at the expense of love . . . (as
The Will to Health

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cited by Ahern, 1995, p. 339). Nietzsche was also
aware of the controversy his work would evoke, as
well the potential for considerable danger should it
be mishandled And even then I am frightened by the
thought of what unqualied and unsuitable people
may invoke my authority one day (as cited by Mur-
phy, 1984, p. 1). Regardless of how we might react to
Nietzsches acerbic attempt to accomplish that for
which he strives namely a critique of Western com-
placency one must acknowledge his sagacious
understanding of what it would take to force us to
examine what might be a system of existence based
on grievous error, passively appropriated presump-
tions, and possibly values contrary to the attainment
of the highest level of health, if not pathological in
themselves.
As Tanner (1990) remarked . . . it is only when we
are made to realize that . . . Nietzsche is launching on
a series of questions that we are made to feel genu-
inely uneasy . . . he succeeds in dazzling us with a
series of increasingly alarming doubts . . . (pp. 11
12). The content of Nietzsches philosophy is princi-
pally the realization that physical, intellectual, and
indeed most notably spiritual comfort and ease are
conditions anathema to human prosperity. To make
the individual uncomfortable, that is my task
(Nietzsche, 1982, p. 50).

The Nietzschean problem
of modernity

Before one can even begin to examine contemporary
health ideology from a Nietzschean viewpoint, some-
thing must be said concerning the

chief complaint

of
Nietzsches thought. He is rather unique, even among
thinkers who have likewise criticized the foundations
of modernity, in that for him the problem of moder-
nity is inseparable from that of Western civilization
as a whole.
Western thought and culture are an amalgam of
Judao-Christian ethics and Socratic rationalism (Bar-
rett, 1962). Nietzsches rancorous attack upon West-
ern thought then is in the form of a rejection of both
rationalism and Christianity. He considered Socrates,
the originator of Western epistemology, to be the pro-
genitor of the Western assumptions and dogma which
he reviled. Socrates is recognized for the rst time as
an instrument of Greek disintegration, as a typical
decadent. Rationality against instinct. Rational-
ity at any price as a dangerous force that undermines
life (Nietzsche, 1989a, p. 271). Regarding Christian-
ity, he had nothing but scorn for it. In the case of the
rst, it was Nietzsches contention that Socrates had
spawned the rationalist epistemology and universal-
istic psychology, which would eventually lead to the
modern age, a disposition which he thought contrary
to the

good

of human beings. It was Christianity that
typied the

transvaluation of values

that Nietzsche
felt to be so degrading to human aspiration (Albert
& Denise, 1988, p. 239). The Christian conception of
humanity is seen as an inversion of values. In other
words, Christianity made sinful and wrong all that
was noble in the human constitution while codifying
what was weak and servile into a false, otherworldly
redemption. For Nietzsche it was modern decadence
which institutionalized the worship of the two most
ill-constituted value systems of Western thought
rationalism and meekness and used it to repress and
control the spirit of human passion and creativity.
It is imperative, however, that we understand
before continuing further that though Nietzsches
entire philosophy is an attack on rationalism, that
views and values . . . should be accepted by everyone
on account of their rational, objective and uncondi-
tional authority (Nehamas, 1985, p. 4), he was not
opposed to human reason as such. To be rational is
not the same as to be reasonable . . . (Barrett, 1962,
p. 270). This is a rather important note in that many
of his critics have quite justiably recognized the
great danger of promulgating a philosophy of uncrit-
ical irrationalism. Indeed, Hitler and other fascist
usurped Nietzsche as

the philosopher of authoritari-
anism

. Although such matters are certainly of great
importance, to say nothing of profoundly complex, in
the interests of time and space, let me just say that no
serious scholar now believes that Nietzsche would
have condoned the fascism of the 20th century.

Utopia and the will to health

As Saul (1995) once remarked Power in our civili-
zation is repeatedly tied to the pursuit of all-
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inclusive truths and utopias (p. 19). What then
could be more utopian than health? Indeed, there
can be little doubt that in the contemporary world
health has assumed the status of a meta-value,
meaning a value upon which virtually all other val-
ues are predicated. As Greco (2004) recently put it
in the context of Western democracies, health today
appears to be endorsed as a kind of meta-value, and
speaking in the name of health is one of the most
powerful rhetorical devices (p. 1). Though this is no
doubt just as healthcare professionals would have it,
a closer examination of this phenomenon, and a
Nietzschean critique of it will, I believe, prove
rather illuminating.
I submit that there are currently two, distinct yet
related and subtly competitive,

grand narratives

of
health. The rst concerns health as a possession, sug-
gesting that it something which can be acquired or
provided:

Under [the] hypothesis of engineerability, health as posses-
sion has gained acceptance since the last quarter of the
eighteenth century. In the course of the nineteenth century,
it became commonsense to speak of my body and my
health. . . . modern-day health is the fruit of possessive
individualism. (Illich, 1990, p. 3)

Hence, we speak of the provision of health health
care usually by those who are educated and trained
(health professionals as it were). However, over the
latter half of the 20th century, the work of, among
others, Thomas McKeown, who pioneered the idea of

the determinants of health

; Hubert Laframboise, the
originator of

health promotion

; and Fraser Mustard,
who instantiated the theory of

population health

, has
led to an understanding of health as a socio-economic
or socio-political phenomenon (Glouberman &
Millar, 2003). Thus, the second health narrative views
health as human need in that the fullment of certain
fundamental needs, with only indirect connections to
health care, generates a condition which we charac-
terize as health. Yet, Most nursing literature treats
needs empirically and refers to specic patients
needs, usually formulated on the basis of Maslows
hierarchy . . . Only rarely has Maslows work been
subjected to critique by nurses (Holmes & Warelow,
1997, p. 464).
What links both conceptions of health is that: (a)
health can be realized, or engineered, in the exercise
of the human will, hence

the will to health

; (b) health,
however dened, is freedom from suffering and dis-
ease; and (c) the attainment of health is dependant
upon the accumulation of knowledge and as a result,
action or intervention in a phrase,

Scientic
Progress

. Thus, while the health engineering agenda
of the rst narrative, health as possession, is aimed
largely at the individual, that of the second is an
attempt to design and control the socio-cultural archi-
tecture in which individuals are enmeshed. The effect
is the same, a pervasive techno-rational project of
engineering for the purpose of realizing health and,
once again, in the socio-political milieu of the early
21st century we have become almost unanimously
convinced that to be healthy is to be free from suffer-
ing and disease. It follows then that that delivery of
health care, the provision of health as it were, is the
relief of suffering and the cure, prevention, and treat-
ment of disease. As Cassel (1982) posits The relief of
suffering and the cure of disease must be seen as twin
obligations of a medical profession that is truly dedi-
cated to the care of the sick (p. 639). It is then as
Miettinen (2001) notes . . . the practice of medicine
. . . [is] not merely scientic but indeed science
proper (p. 591). Healthcare practitioners are cer-
tainly students of science and:

In contemporary [health] parlance, the questions become:
do the causes lie in bad genes?, bad behaviours?, or accu-
mulations of bad living and working conditions born of egre-
gious social policies, past and present? The fundamental
tension, then and now, is between theories that seek causes
of social inequalities in health in innate versus imposed, or
individual versus societal characteristics. (Krieger, 2001,
p. 668)

We nurses are supposed to be taught, and as a rule
claim to subscribe to, a more holistic understanding
of health than mere cause and effect, though it is
hardly noticeable in the orchestration of most nursing
practice, which functions for the most part within a
biomedical paradigm. As Herdman (2001) points out
nursing has embraced the notions of progress and
developmentalism as it aspires to professional status
and attempts to establish Western style nursing
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world-wide . . . which is its alignment with medical
science and technology as the principle route to pro-
fessional status (p. 5). Thus, we remain rmly com-
mitted to

enlightenment

ideals, namely a metaphysic
of materialism, an epistemology of rational-empiri-
cism and a teleology of engineerable health utopia
through techno-scientic progress. For example, wit-
ness MacKays (2003) vision for the future of human
health:

. . . the twenty-rst century should produce even more
momentous medical scientic advances than those of the
recent past. These should include use of data from the
Human Genome Project and applications of cloned and
differentiated human embryonic stem cells, with promise for
customized remedies for most human ailments (i.e. medica-
tions, gene replacements, new tissues). (p. 201)

Can there be any doubt that Contemporary science
is providing ever-expanding knowledge on means to
achieve the goal of perfection of human health
(MacKay, 2003, p. 195)?
By and large, the institutions around which health
currently revolves are still doctors ofces, clinics, and
hospitals. The shortage of doctors, nurses, and other
professionals, perhaps health researchers as well, who
dene health for, and distribute it to the

needy

is
often regarded as a

crisis of health

, one which all too
frequently results in a bevy of political promises to
increase the numbers of such indispensable practitio-
ners. The unceasing social discord regarding the ubiq-
uitously perceived lack of healthcare spending by
governments, as well as the persistent debate con-
cerning the proper means of generating and manag-
ing healthcare dollars, gives one the impression that
if we only had enough money, personnel and commit-
ment, there would be no health problems for individ-
uals to suffer from. On the other side, perhaps one
sees the most extreme version of social engineering
in Layards (2005) recent book,

Happiness: Lessons
from a New Science

, in which he claims, based on the
thought of the enlightenment utilitarian Jeremy
Bentham, that the very purpose of public policy and
hence socio-political organization

ought

to be the
maximization of collective happiness (and by exten-
sion the minimization of suffering) using good sci-
ence. What could be more conducive to health than
happiness and what could be more effective for
achieving it than science?
As a result of

the will to health

, we have come to
believe that health is a fundamental requirement, a
foundational value of human existence (perhaps even
a universal right) from which all other values some-
how follow. Modern health ideology conceives of the
possession of health as that which gives a human
being the strength to pursue its higher needs and
realize its loftier values. Conversely, ill-health is pre-
cisely that which weakens an individual, presenting
an impediment to the fullment of needs and values.
That we have steadfastly continued the project of
easing the human burden comparatively in the name
of health is undeniable. We have apparently set as our
goal, almost exclusively, the evisceration of morbidity
and the unconditional postponement of mortality
(Fukuyama, 2002; Overall, 2003; Turner, 2004). In
fact, so much so that our language permits discourse
concerning little else. As Kottow (2001) so unabash-
edly recognizes . . . cure is rashly offered by the
healthcare professions, in a seemingly endless
upwards spiral towards higher efciency levels, more
perfect restitutions, enhanced states of well being
(p. 58). Or Furedis (2004a) contention that The
vocabulary of therapeutics no longer refers to unusual
problems or exotic states of mind. Terms like stress,
anxiety, addiction compulsion, trauma, negative emo-
tions, healing, syndrome, mid-life crisis, or counselling
refer to the normal episodes of daily life. They have
become part of our cultural imagination (p. 1).
One might posit that the life of the average human
being has been made so easy that it has once again
become hard, by which I mean complex, confusing,
and certainly bordering on meaningless if not patho-
logical in itself. Chio

et al

. (2005) have recently pro-
posed that . . . the human race will be pushed toward
a primary cause of death from diseases of comfort
(such as those chronic diseases caused by obesity and
physical inactivity), due to technological advance
(p. 1030). Or Schwatzs (2004) characterization of

the
paradox of choice

. . . the goal of maximizing is a
source of great dissatisfaction, that can make peo-
ple miserable . . . (p. 78). One is hard-pressed to
deny that it is entirely possible, certainly from the
Nietzschean standpoint that I shall attempt to expli-
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cate below, that this new form of hardship,

the suffer-
ing of ease

if you will, is a matter inextricably bound
to bad values and perhaps an ill-constituted suffering
that slowly kills, initially the spirit, next the virtue,
and nally the body complete. Tarnas (1991) has
even suggested that the post-modern mind is partic-
ularly susceptible to a kind of

cultural schizophrenia

resulting from the hegemonic commitment to
scientic meta-communication as the dominant dis-
course, and techno-rational progress as the dominant
methodology.

Health and the will to power

For Nietzsche, health

is

strength and ill-health

is

weakness, but such a fact has little to do with disease
or the satisfaction of basic needs. Moreover, the
absence of disease or inrmity does not at all suggest
strength and hence health, nor does the possession of
strength in any way imply an absence of suffering.
Although it is somewhat of an oversimplication,
one might characterize Nietzschean strength and
power as the ability to cope, or as Nietzsche would
most likely put it

endure

. More than this though, it
is abundantly clear that of Nietzschean strength we
can conclusively say it is one of unqualied afrma-
tions of life . . . afrmative affects: pride, joy, health,
love of the sexes, enmity and war, reverence, beauti-
ful gestures and manners, strong will, the discipline
of high spirituality, will to power, gratitude toward
earth and life . . . (Nietzsche, 1968, p. 533). Certainly,
there are no concepts of which Nietzsche speaks that
equal the importance in his thought of

The Will to
Power

:

Granted nally that one succeeded in explaining our entire
instinctive life as the development and ramication of one
basic form of the will namely, of the will to power . . .
granted that that one could trace all organic functions back
to this will to power and one could also nd in it the solution
of the problem of procreation and nourishment then one
would have gained the right to determine all efcient force
univocally as will to power. The world seen from within, the
world described and dened according to its intelligible
character it would be will to power and nothing else.
(Nietzsche, 1990a, p. 67)

We must, however, take great care to note that the
term

Will

should not be construed, narrowly at any
rate, as an adumbration of free will, or simple free-
dom of choice. Nor should his use of the word

Power

be taken as merely the expression of purposive
authority and control. Rather

Will

is perhaps better
thought of as an irreducible, even biologically
determined to a large extent, psychological motiva-
tion, and

Power

, the action or effort of growth and
perseverance.
Whereas the current conceptualization of health,

the will to health

, views the human being as a freely
choosing, rational agent engaged in the surfeit of
needs amelioration, Nietzsche (1968) sees the human
being as a . . . a vast confusion of contradictory val-
uations and consequently of contradictory drives (p.
149). Such an unmanaged contradiction of instincts
serves only to result in a chaotic, diseased condition.
Therefore, it is the dominance of one drive and its
exploitation of, or will to power over, the others that
lead to a state of health. The dominating passion,
which even brings with it the supremest form of
health; here the co-ordination of the inner systems
and their operation in the service of one end is best
achieved but this is almost the denition of health
(p. 408).
We must though sound a note of caution here, for
unlike the Greek conception promulgated by Plato,
where the passions are harnessed and managed by

reason

, or

rational order

as the natural order,
Nietzsche (1968) has something altogether different
in mind:

The faith in the categories of reason is the cause of nihilism.
We have measured the value of the world according to cat-
egories

that refer to a purely ctitious world

. . . What we nd
here is still the

hyperbolic

naivet of man: positing himself
as the meaning and measure of the value of things. (pp.
1314)

More to the point though, Nietzsche (1990a) claims
that values are the consequence of, or perhaps the
creation of, a dominating passion wherein the
primary concern of such value derivation is . . . to
what extent it is life-advancing . . . (p. 35). Yet, for
Nietzsche, life-advancing is not by any means merely
the denouement of suffering, or the staving-off of
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morbidity and mortality.

Let us beware of saying that
death is the opposite of life (Nietzsche, 1974, p. 168).
The purpose then, of the

all to human

endeavour, and
as such the realization of a healthy deportment, is to

live

a life, which is to say,

create

values and live them
in passionate commitment not to merely subject
oneself to a set of rationally sensible, scientically
sanctioned rules and caveats for the avoidance of
suffering, sickness, or even death. Put simply, the
Nietzschean health, once again, is a

yes

to life. An
afrmation to

live

in accordance with dominating
and invigorating passion(s), which then form the
desiderata of value formation and determination.
For example, perhaps we should view Illichs (1990)
resounding, though unquestionably divisive, NO to
health as ones own responsibility as an equally
committed YES to life. In other words, if the pre-
eminent impetus of living is: (a) the evisceration of
suffering; (b) the amelioration of disease; and/or (c)
the extensive prolongation of life, then one becomes
in effect more concerned with suffering, dying, or
getting sick than living. Therefore, one says Yes to
suffering, death, and disease in the simple act of
granting it such inordinate importance. And one says
No to life by denying it its due attention. When I try
to structure my life according to such . . . ideas, they
become harmful I make myself sick . . . Health and
responsibility have been made largely impossible
from a technical point of view (Illich, 1990, p. 4). It
appears completely bafing to us, with our episteme
of

the will to health

, that The certain prospect of
death could sweeten every life with precious and fra-
grant drops of levity and now you strange apothe-
cary souls have turned it into an ill-tasting drop of
poison that makes the whole of life repulsive
(Nietzsche, 1989a, p. 185).
Thus, in Nietzsches view, health, as we understand
it, is neither an a priori requirement a meta-value
nor a basic need, but rather a consequence, or per-
haps product, of strength and fortitude. Health is the
result or by-product of the passionate living of values,
of growth and perseverance in the course of a human
life span:

Wellbeing as you understand it that is no goal, that seems
to us an end! A state which soon renders man ludicrous and
contemptible which makes it desirable that he should per-
ish! The discipline of suffering, of great suffering do you
not know that it is this discipline alone which has created
every elevation of mankind hitherto? (Nietzsche, 1990a,
p. 155)

Nietzsche is here noting the discipline of suffering
and its value for human beings. Elsewhere he sug-
gests that What really raises ones indignation against
suffering is not suffering intrinsically, but the sense-
lessness of suffering (Nietzsche, 1989a, p. 68). Rather
than simply being that which is to be avoided alto-
gether, there is unquestionable value in suffering. We
might even speak of it as a value of sorts:

Man, the bravest of animals and the one most accustomed
to suffering, does not repudiate suffering as such; he desires
it, he even seeks it out, provided he is shown a meaning for
it, a purpose of suffering. The meaninglessness of suffering,
not suffering itself, was the curse that lay over mankind so
far . . . (Nietzsche, 1989a, p. 162)

It is from this position that Nietzsche implores us
to recognize that strength and endurance,

coping

if
you will, are indispensable human qualities and to
undermine them with heuristic pathways to satisfac-
tion and ease has potentially dire consequences. What
is it, though, about human suffering that might lead
one to conclude that it not only has value, but indeed
is very possibly a

value

in itself? The answer for
Nietzsche is

resistance

. As Ahern (1995) puts it the
will to power is manifest only in the face of resistance
. . . (p. 32). It is

resistance

that provides the impetus
or motivation for the passion for living that stems
from the will to power:

Man does

not

seek pleasure and does not avoid displeasure
. . . Pleasure and displeasure are mere consequences, mere
epiphenomena what man wants, what every smallest part
of a living organism wants, is an increase of power . . . driven
by that will it seeks resistance, it needs something that
opposes it Displeasure, as an obstacle to its will to power,
is therefore a normal fact . . . man does not avoid it, he is
rather in continual need of it . . . (Nietzsche, 1968, p. 373)

A lack of resistance results is a weakening and
withering of the human compulsion to live, indeed to
thrive and ourish. Nietzsche (1990a) pointedly
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refers to the utopian quest for an abolition of all
suffering as

scientic disguises

that . . . reveals itself
for what it is: as the will to the

denial

of life, as the
principle of dissolution and decay (p. 194). There-
fore, we might very well be able to sum up Nietzsches
essential

problem of health

by wondering with him:

. . . whether we can really dispense with illness even for
the sake of our virtue and whether our thirst for knowl-
edge and self knowledge in particular does not require the
sick soul as much as the healthy, and whether, in brief, the
will to health alone, is not a prejudice, cowardice, and per-
haps a bit of very subtle barbarism and backwardness.
(Nietzsche, 1974, p. 177)

The last man

and the will to health

For Nietzsche, rather than the culmination of some
progressive human improvement project, modernity
represented the climax of the Western

rational

enter-
prise. In effect, the human race had reached its low-
est, most

decadent

,

culturally diseased

state in history,
and the major disease in question is that of nihilism.
However, his own philosophy was forward-looking,
which is to say future-oriented. His

great vision

if you
will was that an epoch would follow the modern age
wherein humanity would transcend its cultural decay
and socio-political destitution. Such a

vision

is char-
acterized throughout Nietzsches work as chiey a
spiritual enterprise, though nothing like that of
Christianity nor any religion of otherworldly dimen-
sions. In fact, as Ahern (1995) puts it, in Nietzsches
view, nihilism is, therefore, a spiritual disease . . .
(p. 149).
Nietzsche differentiated what he referred to as

the
last man

and the

overman

. As Levine (1995) charac-
terizes it The Last man is Nietzsches caricature of
the relativist, nihilist weakling, who, contemplating
the dogmas of the past, can say only: In the past, all
the world was mad. . . . (p. 159). In other words, the
generalized modern individual who is: progressive,
techno-rational, condent in their free will, the pos-
sibility of valid knowledge and the values that follow
there from. In contrast, the overman or superman
(

ubermensch

in Nietzsches original German) is the
human being of the future who is satised with noth-
ing less than greatness, which is to say the highest
afrmation of life and living:

The noble type of man [who] feels himself to be the deter-
miner of values, [who] does not need to be approved of . . .
[who] knows himself to be that which in general rst accords
honour to things, [who]

creates values

. . . [who] aids the
unfortunate but not, or almost not, from pity, but more from
an urge begotten by superuity of power. (Nietzsche,
1990a, pp. 195196)

What is to be said then of the contemporary North
American social value system, from a Nietzschean
viewpoint, when to live, experience, and discover as
human beings is to be constantly in need of specialists,
professionals, and experts to proclaim everything
from: what to eat and how to raise children, to what
is good and what is bad, in virtually every sphere of
existence? Indeed, Nietzsche would shudder to think
of the character of an individual so blessed by the
benecence of the prevailing culture of healthy living
today. As a general rule, we eat what the dieticians
and nutritional biochemists proclaim proper and
exercise as the physiologists and physical trainers
would have us. We work, play, and relax in a manner
dictated by psychologists and lifestyle researchers
and conduct our marriages, raise our children, and
orchestrate our friendships and associations in accor-
dance with the indispensable recommendations of
counsellors, therapists, and sociologists.
Finally, we approach the physician and humbly ask
that he or she x whatever has gone wrong when the
discomfort of our experience overtakes the tranquil-
ity of our ease and languor, with the proviso that we
follow all instructions that might be given. In any
case, we are certainly witness to a fundamental
change in all things cultural. As Phillip Rieff (1987)
put it in

The Triumph of the Therapeutic

That a sense
of well-being has become an end, rather than a by-
product of striving after some superior communal
end, announces a fundamental change of focus in the
entire cast of our culture . . . (p. 261). Fitzgerald
(1994) refers to such a cultural shift as the tyranny of
health. While Fitzpatrick (2001) adopts a similar atti-
tude in his book

The Tyranny of Health: Doctors &
the Regulation of Lifestyle

and Rosenberg (2002) in
turn speaks of the tyranny of diagnosis that . . .
The Will to Health

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labels, denes, and predicts and, in doing so, helps
constitute and legitimate the reality that it discerns
(p. 240). Or Furedis (2004b) claim that a

therapy
culture

[cultivates] a powerful sense of vulnerability,
it undermines subjectivity and the sense of human
agency (p. 414). In fact, another set of diagnoses has
recently begun to creep into the literature of health
and lifestyle theory as a result, no doubt, of

the will
to health

, these being:

medicalization

and

the worried
well

:

. . .

cultural impoverishment

; that is; an uncontrolled growth
of isolated expert cultures . . . [and]

systems colonization of
the lifeworld

; that is, the replacement of communication with
purposive rational adaptation to bureaucratic power or mar-
ket mechanisms . . . captures many of the problems of mod-
ern health care, such as medicalization and the worried
well. (Fredriksen, 2003, p. 287)

Schaler (2002) speaks of the religion of health in
that the doctrine that we are obligated to become as
healthy as we can is a religious one . . . The result is
to establish the medical profession as a priestly caste
. . . (p. 67). Others have also characterized the ideol-
ogy of contemporary health professionals as almost
religious in nature (Nolan, 1998).
One might even observe that we are managed, con-
ditioned, and categorized, not unlike the followers of
religious dogma, down almost to the very minutia of
our lives in a manner that would make B.F. Skinner
proud. How is it not truly ridiculous, then, to profess
responsibility for ones health, indeed ones character
of life? Particularly when the very nature of the busi-
ness of living makes us directly dependant, though
not on each other in what Peat (1994) referred to as
eld of active meaning (p. 121), but rather on what
Saul (1995) referred to as academic specializations
and their [thousands of] impenetrable academic dia-
lects, which have become in turn the veils of govern-
mental and industrial action (p. 70). Most of which
operate on the universalizing ethos of scientic epis-
temology and techno-rational metaphysics.
Pending the next battery of published, peer-
reviewed studies that are adjudged methodologically
sound and scientically rigorous, we are prepared to
listen attentively, alter our routine as needed, our
values as ordered and quite properly do as we are
told. Add to this the inevitably occurring Kuhnian
paradigm shift that will likely take place over the next
half century or so in healthy lifestyle theory and
again we await the educated command to restruc-
ture and re-engineer all that we do, all that we are, all
that we know and value, all in the service of own good
of course. And yet, it might be argued that . . . a
majority of these medical achievements are deceptive
misnomers . . . (Illich, 1990, p. 5).
More than this though, the very fact that even
under harsh and inhospitable conditions of existence,
there are those who thrive and prosper has led to the
contention that chief among the predictors of health
is the idea of coping . . . there is now a better appre-
ciation that how well individuals cope with the chang-
ing environments in which they live and work
throughout the life cycle strongly inuences their
health and well being (Mustard, 1998). In fact,
Nietzsche would surely retort that we know nothing
of value much less values that we have not been
the generalized nding recipient of. Whats more, if
we were to deviate at all from the socially sanctioned,
expert recommended health edict and thereby nd
ourselves aficted with cancer, or diabetes, or cardio-
vascular disease, or what not, it is we must surely
surmise our own fault. As Leichter (2003) recently
commented Americans at both the beginning and the
end of the 20th century were assigned much of the
responsibility for their own ill health and premature
death as the result of some personal weakness (p.
622). Worse yet, if even in the case of faithful adher-
ence to the health regime we succumb to disease, it
can only be concluded that we are simply one of the
unlucky who fall inexplicably on the unfortunate side
of statistically signicant truth. As Fitzgerald (1994)
puts it We excoriate the smoker but congratulate the
skier. Yet, both skiing and smoking may lead to injury,
may be costly, and are clearly risky (p. 197). Though
if Furedi (1997) is correct we might well consider a
future ban on skiing, his reference is to mountain
climbing, and any other

potentially unhealthy

endeav-
our. Such is the

Culture of Fear

that sees anything but
banal experience and behaviour as risk(y).
It is little wonder that in response to the prospect
of living rationally, in existing scientically, as the
current health regime would have us, Nietzsche was
46

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2007 The author. Journal compilation 2007 Blackwell Publishing Ltd

Nursing Philosophy, 8, pp. 3748
compelled to contend that . . . all science, natural as
well as unnatural . . . has at present the object of dis-
suading man from his former respect for himself, as
if this had been nothing but a piece of bizarre conceit
(Nietzsche, 1989a, pp. 155156). Indeed, regarding
the apparently innite Progress of the current techno-
rational empire of health, perhaps a reasonable indi-
vidual that is, one concerned with human values
might conclude that the recent science ction like
development in biotechnology, neuropharmacolgy
along with cosmetic surgery, cosmetic phar-
macology, or cosmetic neurology (Fukuyama,
2002; Wolpe, 2002; Chatterjee, 2004), represents a
paradigm shift from one of disease-cure to cure-
enhancement. Furthermore, the same reasonable
individual might also be truly frightened, if not hor-
ried, by the recent appearance of works such as:
Fukuyamas (2002) Our Posthuman Future, Stocks
(2002) Redesigning Humans: Our Inevitable Genetic
Future, McGees (2000) The Perfect Baby: Parent-
hood in the New World of Cloning and Genetics,
Silvers (1998) Remaking Eden, Clarks (1997) The
Promise and Problems of Molecular Medicine in the
Twenty-First Century, and others to be sure.
Finally, this increasingly hypothetical, reasonable
individual might be compelled towards a serious crit-
ical response concerning everything from the quasi-
therapeutic use of drugs such as Prozac and Ritalin
to body enhancement and genetic modication, all of
which must now be considered under the umbrella of
human health. On the other hand, maybe it is as Kass
(as cited by Fukuyama, 2002) put it, in reference to
Huxley Unlike the man reduced by disease or sla-
very, the people dehumanized la Brave New World
are not miserable, dont know that they are dehuman-
ized, and, would not care if they knew. They are,
indeed, happy slaves with a slavish happiness (p. 6).
Yet, perhaps these are all quite rational responses
when the overriding value is the avoidance of suffer-
ing, morbidity, and mortality and to be sure Progress
towards a social order of ease, comfort, safety, and
security, in short the will to health Formerly, all the
world was mad . . . We have invented happiness,
say the last men . . . (Nietzsche, 1968, p. 130). It is not
at all surprising then that when Nietzsche says For
believe me: the secret for harvesting from existence
the greatest fruitfulness and the greatest enjoyment
is to live dangerously! (Nietzsche, 1974, p. 283), we
recoil in horror and denounce such views as anything
from misanthropy to madness.
If Nietzsche would almost surely view our contem-
porary will to health as decadence, what indeed would
his recommendations for healthy existence be? The
answer is, of course, what I have endeavoured to
explicate hitherto. That is, values that are not deter-
mined (exclusively at any rate) by objective method-
ology or utopian systems of truth, fear of discomfort,
panic at the thought of disease, and horror in the face
of a death that even modern medicine cannot ulti-
mately prevent, but rather passion, vitality, spiritual
strength, intellectual courage, and honour and when
it all comes to nal fruition, as it indisputably must:
To die proudly when it is no longer possible to live proudly.
Death of ones own free choice, death at the proper time,
with a clear head and with joyfulness, consummated in the
midst of children and witnesses: so that an actual leave-
taking is possible while he who is leaving is still there . . .
(Nietzsche, 1990b, p. 98)
Concluding remarks
Perhaps in explicating and critiquing what I have
referred to as the will to health, I have somewhat
overstated the point. If this is the case, I have
attempted to do so in the Nietzschean spirit of critical
passion. Furthermore, I do not claim to have pre-
sented the full extent of Nietzschean thought, but
rather a glimpse into an insightful thinker and a view
to human health commensurate with such thought.
Nietzsche is an indispensable thinker, for as Grant
(2001) correctly notes . . . Nietzsche thinks what it is
to be a modern man more comprehensively, more
deeply, than any other thinker . . . Therefore the rst
task of somebody trying to think . . . is not to inocu-
late, but to think his thoughts (p. 64).
I have quite obviously not attempted any critique
of Nietzsche. It certainly should not be construed
from such a lacuna that this paper is, in any way, a
declaration that Nietzsche is nally correct. However,
as Bloom (1987) so cogently put it [Nietzsche] may
not have been right, but his case looks stronger all the
The Will to Health 47
2007 The author. Journal compilation 2007 Blackwell Publishing Ltd Nursing Philosophy, 8, pp. 3748
time (p. 51). Neither has it been my purpose to sug-
gest some manner of idolatry concerning Nietzsche.
For as he once admonished one repays a teacher
badly, if one remains only a pupil (Nietzsche, 1968,
p. 103).
We cannot look to Nietzsche for a system to x
what ever it is that might be wrong with ours. Unlike,
for example, Rousseau, Hobbs, Locke, Marx, and
others, it is never Nietzsches intention to set out a
view of the social order which follows from his phi-
losophy. Neither is Nietzsche ever content with sim-
ple systems of explanation, understanding, and of
course a pervasive ideology of intervention that is
thought to follow. Yet, as Theodore Adorno (Adorno
et al., 2001) claimed Precisely the point where
[Nietzsche] refuses to provide his philosophy with
prescriptive instructions is its moment of truth (p.
135). Moreover, Allen (1992) is probably correct
when he asserts that: Nietzsche is better at provok-
ing questions than answering them . . . (p. 228).
Though we are certainly now in need of serious ques-
tions, there is a signicant danger in gleaning from
Nietzsches philosophy simple prescriptive models
that one can apply to circumstances of human exist-
ence as a convenient manner of determining the spe-
cics of what is and/or ought to be. Indeed, I would
suggest that simple prescriptive instructions are very
likely some where near the core of the problems we
must face up to.
Perhaps the area where Nietzsche succeeds so fun-
damentally is that, in making us, his careful readers,
uncomfortable, he manages to force an honest and
penetrating examination of those assumptions which
we have somehow come to regard as self-evident.
Regarding the future of human health conceptualiza-
tion, I will give the last controversial words to
Nietzsche (1980) Dare to devote some thought to the
problem of restoring the health of a people which has
been impaired by history, to how it may recover its
instincts and therewith its integrity (p. 25).
Acknowledgements
The author wishes to give kind thanks to Dr Barry
Allen and Dr Edward Smith for reviewing and com-
menting on the manuscript and providing valuable
feedback. Thanks also to Andrea Smith-Betts for
grateful assistance and a very special thank you to Dr
Joan Liaschenko for going well beyond what one
expects of an editor.
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