Without A 'Why' There is No 'How' In Health

Friedrich Nietzsche famously said that

“He who has a why can bear almost any how”. 

Caspar David Friedrich: Two Men by the Sea 1817

This quotation was popularised by Austrian psychiatrist Victor Frankl, the author of “Man’s search for meaning”, when describing his experiences of spending four years in Nazi concentration camps during World War 2.

His ‘Why’ was very simple.


His ‘How’ is a series of harrowing experiences during that time and is best appreciated by reading his book. Something I do at least once a year.

For Frankl, the ‘Why’ was very clear. And because of that, the motivation to adhere to the ‘How’ was very high.

When it comes to cardiovascular risk, it’s the same challenge.

But in reverse.

The ‘How’ is very clear.

It’s the ‘Why’ where I see people fall down the most.

Let’s re-examine Nietzsche’s quotation.

He who has a why can bear almost any how


For he who has noWhy’, why would you bear any ‘How’?

All the steps needed to reduce cardiovascular risk typically require effort. Not adhering to them is generally the easier path.

It’s easier not to exercise.

It’s easier to eat processed foods containing sugar.

It’s easier not to focus on going to bed early.

It’s easier to keep smoking and not stop.

It’s easier not to take medications for high blood pressure or cholesterol.

The list goes on and on.

In truth, ‘Why’ would you do any of these things?

Sure, you might live longer.

But our denial of death is deeply engrained in our psyches and is likely something we ignore far more than we think. Most of us believe we will live forever in some way, shape or form.

Don’t think so? Check out my previous piece on ‘The Search For Immortality’. 

A skeleton, seated on his grave, awakes to the last trump on judgement day. Etching by Martin after J. Gamelin, 1778/1779.

But it will improve our health span? And we will be less likely to develop the chronic diseases most likely to kill us?


‘Why Prevention Is So Hard’ is something I have also written about previously.

It’s not to say that living longer or with a better quality of life are not realistic goals, but they tend to motivate us far less than we think.

We usually need a deeper goal.

I want to live a longer, healthier life and this does, in part, serve as my ‘Why’ to put in all the effort to optimise my cardiometabolic health.

However, it’s only a part of my ‘Why’.

If most people were honest, they would admit they wanted a longer and healthier life but weren't motivated enough or incentivised enough to make the difficult changes required.

I believe people desire these things, but their ‘Why’ is simply lacking. Or their environment is structured in such a way as to seriously incentivise them otherwise. But even when your environment is optimal you still need to consider your ‘Why’.

This is where the element of Soul Span comes into play.

The ‘Why’ of your life.

The meaning and purpose of your life.

With a big enough incentive, people are capable of anything.

Take quitting smoking, for example. On average, it can take between 6 and 30 attempts to stop smoking1.

However, I have routinely seen smokers stop immediately the day after a heart attack. These people had tried to quit before, but it wasn’t until they had a big enough incentive or ‘Why’ did they stop completely.

All of us will die.

All of us will likely develop one or more chronic diseases over our lifetime.

The only certainty is that we will have a limited amount of time and a good quality of life to do what means the most to us.

As Dostoevsky says:

For the mystery of human existence lies not in just staying alive, but in finding something to live for.”

When it comes you your life, what is that something to live for?

Friedrich, Moonrise over the Sea, 55 x 71 cm, Alte Nationalgalerie, 1822 | © Dcoetzee/WikiCommons

When we answer that question honestly, we realise the importance of our available time.

And in recognition of that importance, we are then motivated to make the changes necessary to be around longer and in better health to participate in our ‘Why’.

But two things often stand in our way.

Most people know what it is they want to do with their lives. Deep down, they know their ‘Why’. The challenge is that achieving that goal will likely require a tremendous amount of work. It will likely mean that significant changes will have to be made, and with these changes will likely come a lot of uncertainty.

In truth, pursuing your ‘Why’ is hard.

But guess what?

If you do not pursue your ‘Why,’ you will likely pay an even greater price. You will always live with the knowledge that you did not pursue what was most meaningful and impactful to you. You will likely forever experience the anguish of ‘what could have been’.

So not pursuing your ‘Why’ is also hard.

In the end, you simply get to ‘choose your hard’.

But if you choose the path of your ‘Why’, at least the ‘hard’ will feel worthwhile.

The second challenge that we face in pursuing our ‘Why’ is the sense that we will only be content or happy when we have arrived at the destination of our ‘Why’.

We all do this.

When I achieve this goal.

When I get this promotion.

When I buy this house. 

Then. Then I will be happy.

You won’t. At least not any more than you already are now.

That’s not to say that pursuing your goals will not make you happy or give you a sense of meaning or purpose.

But the achievement of those goals is unlikely to.

The pursuit of them likely will, however.

Our sense of meaning, purpose and happiness is derived from moving toward our ‘Why’.

It is not a place we ultimately arrive at.

In the words of the Bhagavad Gita,

“We have a right to our labour, but not to the fruits of our labour.”

It might seem cliche, but life's real ‘Why’ is a process of movement and not a destination.

It is the sense of meaningful progress toward a higher goal, not the ultimate achievement of it.

That is why you must be happy or content on the path and not hold out for some magical time in the future as to when it will all come together.

Because if you are unable to enjoy the process today, what makes you think you will be able to enjoy the gift of more time in the future?

Even if you do everything right from a life span and health span perspective, if you cannot be fulfilled in the day-to-day actions of today, what is the point of all these additional days and years in good health?

Life span matters.

Health span matters.

But they only matter to be in service of your ‘Why’.

What is your ‘Why’?

Because if you cannot answer that question honestly, there is likely to be no ‘how’ that will ever work for you. 


Chaiton M, Diemert L, Cohen JE, et al. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open 2016;6:e011045. doi: 10.1136/bmjopen-2016-011045

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