A recent history of the 20th-century movement to fix slouching questions the moral and political dimensions of addressing bad backs over wider public health concerns.
"Imagine a string pulling the top of your head towards the ceiling," my barre instructor announced to the room. My body was shaking. I looked around the packed studio and saw a sea of predominantly white bodies in matching workout sets, all striving for an ideal elongated frame. Our instructor invited us to smile through the pain, as if baring one's teeth could evaporate discomfort. After my first class, I received a handwritten postcard from the studio. An anonymous staff member, writing in pink gel pen, congratulated me on "100% embracing the shake!" I immediately threw out the card. But the next day, I signed up for another class.
As an internal medicine resident, my job largely consists of sitting in a chair. I run around the hospital and see patients, but that's only a small fraction of my day. I am usually hunched over a desktop in a windowless workroom. I don't need a mirror to know my posture is horrific. The exhaustion of residency has made me feel estranged from my own body. Barre -- with its focus on posture and alignment -- brought an awareness back to my physical self that the years of school and residency had taken from me. I took the skills I honed in barre to the hospital, smugly tightening my core as I looked at my fellow residents slouched over their computers. I then noticed that my elongated spine brought benefits that transcended the physical: Were my male attendings taking me more seriously? Did my patients regard me as displaying more authority? Could good posture make me feel like a more competent doctor?
We've all been told to stand up straighter. But the scold isn't necessarily connected to our health.
The back's central place in the psychodrama of our personal health is so commonplace that we don't really question its origins. Beth Linker, a historian of science and former physical therapist, uncovers just how recent our obsession with posture is in Slouch: Posture Panic in Modern America. What she finds is a moral panic, one that began in England at the turn of the 20th century with the rise of evolutionary science and its impact on human health. Posture migrated from a debate over anatomical development to a concern that popped up everywhere throughout the 20th century, a symptom tied to a whole host of anxieties around race, class, and industrialization.
How did concerns about posture become so ubiquitous? Instagram ads featuring posture-enhancing technologies like standing desks, ergonomic chairs, smartphone apps, and the FDA-registered posture-correcting bra that Taylor Swift wore while training for her Eras Tour consume my feed. And why have we attached so much meaning to posture? A child sitting upright at the family dinner table continues to symbolize respect, and colloquialisms like "upright citizen" signal virtue. Some people may purchase the viral posture bra because they feel a taller stance makes them more attractive or commanding. Others feel the bra or standing desk actually improves nagging back or neck pain. There is a blurriness here: How much of this concern with posture is a moral panic or pseudoscience? And to what extent might poor posture and its contribution to pain be a legitimate issue?
Linker's history opens in the late 19th century, with a debate concerning the first step in human evolution. The question at hand: Did the human brain develop before humans stood upright or after? Charles Darwin was a member of the "posture-first" camp, using the principles of natural selection to argue that humans' ability to stand upright preceded brain development. Darwin's stance was controversial because he claimed that a small physical difference -- rather than an intellectual one -- was what initially separated humans from apes. While Darwin wasn't a medical doctor, his ideas circulated among British and American paleoanthropologists who also happened to be physicians. These physician-paleoanthropologists had a stake in applying evolutionary science to clinical practice and became fixated on posture as a tangible "indicator of evolutionary fitness," Linker writes.
Ever since Darwin identified posture as an important evolutionary trait, anxieties about the social order were projected onto it. Beginning in the post-Victorian era, the emergent professional middle class regarded the aristocratic leisure class with disdain, dubbing their slovenly stance the "debutante slouch." The working class came under similar scrutiny in America: Factory workers, often recruited from the ranks of recent immigrants, hunched over their machines, ruining their backs in the process.
Regardless of class, the demands of an industrialized economy undeniably affected human posture. The creation of Henry Ford's assembly line -- informed by the principles of "Taylorism" -- made work increasingly repetitive and stationary, contributing to the rise of medical conditions like flat feet, scoliosis, and back pain. Poor posture was everywhere, and it needed to be corrected. Or at least that's what the emergent "posture scientists" thought. The proponents of posture science were far more concerned about correcting bad backs than addressing unsafe working conditions, a more serious driver of poor health outcomes.
Before posture could become a true issue, even a medical panic, it needed to become a legitimate science to have staying power. Linker deftly tracks the medicalization of posture, starting with the American Posture League (APL), an organization founded in 1914 by Jessie Bancroft, a physical educator from the Midwest known for her commitment to the "new physical education movement," where an emphasis on the "psychosocial" aspects of exercise figured prominently. Prior to founding the APL, Bancroft was the assistant director of physical education for New York City's vast public school system in 1904. Bancroft took advantage of this position of power to use New York's most vulnerable children as a canvas for correcting what she deemed to be an epidemic. The APL -- whose ranks included orthopedic surgeons and other medical doctors in addition to physical educators -- would be formed a decade later, with the goal of spreading awareness about the negative health effects of poor posture on a national scale.
Bancroft was not interested in New York City's privileged children. Rather, she wanted to study immigrant children who lived in "the crowded tenement section, where undeveloped standards of living, ethical sense, personal ambition and ideals, and an embittered attitude toward all government, formed the basic problems for our country." Posture could be used not only to correct future health problems but to further American nationalism, policing the bodies of the immigrant populace under the guise of science. This nationalistic drive would come to define the mission of the APL, whose members viewed themselves, Linker writes, as "vital to the Americanization process, molding the bodies of would-be citizens."