In this paper, I investigate Nietzsche’s views about realism in art, and use the resulting textual evidence to explain the connection between realism, health and life-affirmation. First, I show that Nietzsche’s contrasting claims about artists like Flaubert and Stendhal reflect a distinction between two types of realism: the unhealthy realism of Flaubert, and the healthy realism of Stendhal. I then use this understanding of healthy realism in art to argue that for Nietzsche, healthy realism is vital for life-affirmation. Finally, I (...) apply this evidence to a debate between Daniel Came and Bernard Reginster concerning whether Nietzsche thinks life-affirmation requires falsifying reality using illusions, especially artistic illusions, for the purpose of masking life’s terrible truths. Against Came, I argue that Nietzsche’s remarks about realism in art support Bernard Reginster’s claim that Nietzsche abandons his emphasis on illusion in The Birth of Tragedy in favor of tough-minded realism about life’s terrible truths. (shrink)