‘THAT WHICH DOES NOT KILL US MAKES US STRONGER’

—FRIEDRICH NIETZSCHE

Far be it from me to criticise the philosopher and supreme intellect Friedrich Nietzsche, so of course I won’t. Much like all the others mentioned in this book, he’s deserving of admiration. But this one quotation – these nine comforting words – have remarkably stood the test of time since they were first penned in the late 1800s. But how true are they? Are we really strengthened by that which does not destroy us? Sometimes, yes. Oftentimes, not. Indeed, ‘despite the familiarity of the adage that whatever does not kill us makes us stronger, the preponderance of empirical evidence seems to offer little support for it’.

Now, I have to declare a bias. I have not sought to offer a balanced view in this book. Neither have I sought to provide the most comprehensive scholarly analysis of each motivational position. I’ve merely sought to poke holes through perceived truisms that don’t deserve to be considered truisms; at least, not in the absolutist terms in which they’re commonly framed. But the authors of the statement that ended the preceding paragraph certainly did seek a balanced perspective. They genuinely wanted to find out whether that which doesn’t kill us does indeed make us stronger, so they looked at a construct referred to as ‘cumulative adversity’, which is when people are confronted repeatedly by a number of negative events. The scholars surveyed roughly 2000 people five times over a period of two years in order to track not only the adversities by which they were burdened but also the impact these had on their levels of long-term distress, life (dis)satisfaction, functional impairment and stress.

Unsurprisingly, the researchers found that the more individuals experience cumulative adversity, the greater their subsequent levels of distress, dissatisfaction with life, functional impairment and post-traumatic stress. But here’s the most curious finding of all: ‘People with low lifetime adversity reported better outcomes over time than did people who had experienced no adversity.’⁷² That means there is some truth to the saying that whatever doesn’t kill you makes you stronger – but only if what almost killed you is moderate in its impact. Should it be severe, which one can safely assume is usually the case in a near-miss metaphorical homicide, well, grave consequences almost certainly ensue even if you’ve been spared the grave.

Let’s look at one adverse event in particular: job loss. Many studies have already demonstrated the mental health implications of being fired. That’s because the involuntary loss of one’s job damages a person’s self-esteem, since our identity, relationships, status, finances, skill utilisation and more are often attached to the work we all perform. One argument, though, could be that those consequences are short-term. Once they subside, the sacked employee might look back and realise how much better they are now, how much they’ve learned, how much they’ve grown. Or not. In research much like the one noted above, more than 600 employees whose employment was recently terminated were tracked for a period of two years so that the scholars could assess the physical and mental impact of their situation. What they discovered was that being sacked and the ensuing period of unemployment and financial strain resulted in higher rates of depression, which can subsequently trigger a sense that one has lost control, thereby further eroding physical and mental health.

Now, here’s what makes that study especially interesting. It’s not just that those consequences remained stable for at least two years. It’s also the simple fact that job loss is, in many respects, reversible. It’s possible to be hired somewhere else in some capacity. And yet, despite the potential reversibility of unemployment, the physical and psychological scars remain. A downward spiral can also begin. For many participants, the depression that emerged following the termination of their employment debilitated them such that their chances for re-employment were hindered.⁷³

So that’s what happens when it’s a one-off event that could, theoretically at least, still give its victims a glimmer of hope. You can probably imagine the enduring impact when that which does not kill us is not an event but a condition – such as a chronic disease – whereby ‘the cumulative burden of adversity interferes with overall coping’. This burden of adversity can be something as mild as anxiety, which in itself is far from a mild psychological state, to post-traumatic stress disorder, which can be debilitating.

As an example, let’s look at a heart attack. The medical episode itself is not the only adverse event. The cumulative burden that then follows includes the new nutrition regimen to which the patient must adhere; the unexpected complications that materialise; the ongoing physical pain; the impact on one’s social life; the impact on one’s self-esteem; the risk it could all happen again; the ongoing medical tests; the process of rehabilitation; the undesired changes to one’s lifestyle; the funding of medical bills; and so on. It’s no wonder that many studies have found that a heart attack that hasn’t killed someone hasn’t necessarily made them stronger. If anything, it’s made them weaker, as depression and PTSD frequently set in. Patients’ capacity to cope is often diminished. This may ‘explain why individuals frequently fall short of meeting clinician expectations regarding adherence to medical regimens, especially timely care seeking . . . especially when cumulative adversity may promote avoidance . . . and distort perception’.⁷⁴

Let’s look at one final example, this time from childhood. If Nietzsche’s idea is correct, then traumas that children suffer should strengthen rather than weaken them, especially as they enter adulthood and reflect on what they have endured. Right? You and I both know the answer, so feel free to skip the next paragraph.

Okay, you’re still with me. I’ll keep it short. A survey of almost 11,000 adults enquired as to the participants’ history of childhood physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect. Those who had been the victims of such crimes were found to be significantly more likely to grow up as adults who were less stable, more sensitive, more anxious and angrier, and who had greater difficulty coping with the vicissitudes of life. These individuals were labelled not stronger but ‘maladaptive’. The only exception was in relation to physical maltreatment, which appears to not be as harmful in the long term as emotional and sexual abuse – in which case, as the scholars note, ‘what does not kill me makes me weaker’.⁷⁵

Nietzsche can be forgiven. Almost all the research disproving his theory was conducted after his death. Still, his quotation can’t avoid a much-needed edit:

‘That which does not kill us usually makes us weaker, and only occasionally stronger.’

 

72M.D. Seery, E.A. Holman & R.C. Silver, 2010, ‘Whatever does not kill us: Cumulative lifetime adversity, vulnerability, and resilience’, Journal of Personality and Social Psychology, vol. 99, no. 6, pp. 1025–1041.

73R.H. Price, J.N. Choi & A.D. Vinokur, 2002, ‘Links in the chain of adversity following job loss: How financial strain and loss of personal control lead to depression, impaired functioning, and poor health’, Journal of Occupational Health Psychology, vol. 7, no. 4, pp. 302–312.

74A.A. Alonzo, 2000, ‘The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity’, Social Science & Medicine, vol. 50, no. 10, pp. 1475–1484.

75R. Sudbrack, P.H. Manfro, I.M. Kuhn, H.W. de Carvalho & D.R. Lara, 2015, ‘What doesn’t kill you makes you stronger and weaker: How childhood trauma relates to temperament traits’, Journal of Psychiatric Research, vol. 62, no. 1, pp. 123–129.