Examining 20th-century America’s obsession with poor posture, a forgotten ‘epidemic’

While researching her last book, an exploration of how Americans wounded in World War I were rehabilitated, historian and associate professor Beth Linker came across a box full of foot tracings in the National Archives in Washington, D.C. 

In the early 20th century, certain doctors began to see flat feet as a serious pathology. The medical profession took foot tracings in order to determine whether men would be permitted to enter military service, whether they would be excluded, or whether they would be placed in a training program to correct this “defect” in their anatomy.

“Sometimes an artifact can capture your imagination,” says Linker. “I felt that I needed to explain these somehow.”

That find has guided Linker to her next book, “Slouch: The Forgotten History of America’s Poor Posture Epidemic,” due out in 2020. The work examines the scientific and social preoccupation with posture in the United States that began in the late 19th century, and only faded late in the 20th. Poor posture, flat feet, and curved spines were all seen as bodily weaknesses that demanded medical attention, lest the health of individuals and the nation spiral downward. 

This concern for posture “had a lot of weight and power, even though it might seem frivolous to contemporary eyes and ears,” Linker says.

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Seen through a broader lens, Linker’s project frames poor posture as a non-contagious epidemic, one that “experts” feared a significant fraction of the country suffered from. Linker sees the same kind of societal concerns at work today, particularly with growing rates of obesity in the U.S. and other developing nations. Obesity, like poor posture, Linker says, can be construed as a non-contagious epidemic. 

“I find the posture epidemic as a kind of a precursor to the current so-called obesity epidemic,” she says. “There was a stigma attached to slouching bodies, just as there is to obese bodies today, and I’m interested in the moral policing that comes into being through the language of medicine and science and how it permeates the culture and sets the standards for defining normality.”

Linker herself has long been interested in the body and how it is and has been observed, monitored, measured, and pathologized. Before her career in academia, she worked as a physical therapist. Posture evaluations were part of nearly every physical exam she conducted. Yet while these evaluations were intended to identify weaknesses in patients who already suffered from an injury, posture exams were once part of a universal screening process in many schools, universities, and other institutions, including the military.

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“Many of those who were flagged with ‘poor posture’ were probably pain-free,” Linker says. “So the ‘problem’ of poor posture was something in the eyes of physicians and physical educators (or parents!), not necessarily in the subject being examined.”

Linker traces the focus on poor posture to the post-Darwin era of the late 19th century, when it became widely accepted that human beings shared a common ancestor with other primates. 

“One significant way in which we differ from primates is standing erect, bipedalism, walking,” says Linker. 

Some researchers in this period posited that humans were not built for walking upright and thus had to continually fight against the urge to return to hunching over and walking on all fours. As the 20th century began, leading experts on posture argued that poor posture was the culprit for a variety of acute and chronic illnesses, caused by putting unhealthy pressure on the internal organs. The condition was given a clinical name: viceroptosis. Posters declared, “Poor posture encourages tuberculosis. Erect carriage combats it.”

Having a slouched form, in this time period that became known as the Machine Age, was considered a “disease of civilization.” Fewer people held down jobs that required physical strength, more lived in cities, and children were mandated to attend school rather than work on farms. 

“There was a real concern about human beings becoming physically weaker,” Linker says.

This fear became especially acute in the run-up to World War I, when a “war-ready” nation—a physically fit nation—was seen as a matter of national security. Around this time, physical education programs from elementary schools to colleges began incorporating abdominal muscle exercises. Pilates, with its emphasis on core muscles as the body’s “powerhouse,” was invented in this era. Schools began posture competitions. Pupils with admirably upstanding forms were awarded posture pins. 

One of the most lasting legacies of the focus on posture, however, is the existence of troves of posture silhouettes and photos taken by schools, universities, and the military to check for poor form in students and soldiers. Experts who took these photos would also grade them, giving each an A, B, C, or D.

“These photos served as big data. The posture grades could be statistically rendered to reflect health—or in this case disability—at a population level, thereby supporting the epidemic logic,” Linker says. “You see these photos in World War I, World War II, and the Korean conflict. The cadets at West Point are all having their posture examined. Students at Harvard, Yale, the Seven Sisters schools, Stanford, American University, George Washington University are having posture photos taken. And then it begins to happen in elementary schools as well.”

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Notable figures, among them Hillary Rodham Clinton, George W. Bush, Meryl Streep, and Diane Sawyer, were all part of this then-routine process of posture documentation. Though clinical in nature, the photos depicted nude or nearly nude subjects and have been the source of controversy and even scandal since they were phased out in the 1960s and 1970s. 

William Sheldon, a physician and psychologist, infamously used the photos in the 1930s and 1940s to craft his theory that an individual’s body type was correlated with personality and couldn’t be changed, findings that have since been dismissed as pseudoscience and linked with eugenics.

By the 1970s, coinciding with the rise of the women’s movement, the practice of taking nude photos fell out of favor. Linker found that many universities ordered their archivists to destroy the photos. 

“It was surprising to me how quickly the mores changed,” Linker says. “All of a sudden a completely normalized ritual that was seen as cutting-edge science becomes taboo.”

Though the epidemic may be past, attention to posture hasn’t disappeared. “The premise on which all of posture science is based never really gets confirmed or disputed; it just filters out into different places and different specializations,” Linker says. “The belief that good posture is necessary for good health can be found in yoga, in different fitness trends, in beauty pageants. It’s still there as a kind of folk wisdom that hasn’t been validated one way or the other.”

Linker points to new ways that technology is being used to attend to our bodies, citing the FitBit and associated apps that buzz and vibrate to ensure that people are moving enough.

“Body discipline used to happen because other people were monitoring your posture. There is far more self-monitoring in the 21st century,” she says.

Though it is still in the works, Linker’s efforts on “Slouch” have garnered widespread attention and plaudits; she’s won fellowships to support her research from the National Endowment for the Humanities, American Council of Learned Societies, and National Institutes of Health, also earning recognition from the National Humanities Center.

Insights from her work, she hopes, will shed light on how norms about bodies are developed and on how to avoid discrimination when bodies don’t meet those standards. 

“Most of the literature on epidemics is about acute diseases,” Linker says. “In an era of rising rates of diabetes, ADHD, and obesity, I think people are now taking seriously the idea of a non-contagious epidemic and wondering how we should think about an epidemic if there isn’t a germ or a contagion causing it. What if the epidemic is, at base, defined as a bodily defect or disability? On what basis is that bodily pathology defined, and does it warrant preventative or curative measures? Once it is defined, how do you prevent discrimination against those people with the said debility? There hasn’t been a lot of scholarship on that and I think that’s why the project has captured people’s attention.”

Beth Linker is an associate professor in the University of Pennsylvania’s History and Sociology of Science Department in the School of Arts and Sciences.