(Investigator 63, 1998 November)

The Posture Theory, by M. A. Banfield published by M. A. Banfield, 1997, 8th edition Adelaide.

This book appears to have been comprehensively researched, possibly too extensively since many of the sources from which the author quotes are superficial and extremely suspect, suggesting that, in his desperation to find material supporting his theories, he was prepared to use anything, no matter how insubstantial it might be.

Essentially the author's objective is to prove that, "…poor posture is the major, previously unrecognized cause of the symptoms of hypochondria." [p. 16].

Claims such as, "… there is clear evidence that the extreme symptoms of hypochondria and hysteria in the latter half of the nineteenth century were due to abdominal compression caused by the extremely tight whalebone corsets being worn in combination with bustles and heavy frocking…" [p. 17], are repeated throughout the book. It is the claim of the author that hypochondria is an important component of many aspects of ill-health, and that the extensive range of physical disorders in which it is manifested are all caused by, "…poor posture, and tight belts, corsets, or pregnancy, and electrocution…" [p. 211].

One initial problem is that the author fails to adequately explain that when he refers to "hypochondria" he is using the term in its original context, rather than in its more commonly accepted modern meaning. He does mention, briefly, in his Introduction, that, to the ancient Greeks, hypochondria referred to a variety of disorders experienced in those organs which lay beneath the rib-cage, (hypo = beneath + chondros = cartilage - of the ribs).

In more recent times however, the term has come to be more synonymous with "a chronic, abnormal concern with the health of the body." (Mosby's Medical and Nursing Dictionary), a form of neurosis, in which the patient may actually manifest physical symptoms appropriate to specific disorders, even when such disorders are imaginary.

The author has a marvellous ability to see poor posture and compression of these organs as the principal cause of almost every physical ailment in modern Western societies. To this end he examines virtually every conceivable physical health disorder, attributing each to one or the other, or a combination of these two factors. He claims that these idiosyncrasies contribute to a condition called visceroptosis, (a medical term now rarely used), where the internal organs "are displaced downwards." [p. 172], and that this displacement, produced by poor posture or restrictive clothing, is the principal contributory agent in all of the ailments which occur in these organs.

Such a theory is fraught with many difficulties. The main problem is that while this idea was proposed by a number of 19th century doctors, like so many "scientific" theories of that era, it has been almost totally rejected by modern medical authorities. So, with virtually no modern research on this subject, the author has to rely upon "research" and miscellaneous publications from the 19th and early 20th centuries, and he uses these to fill his book, using an enormous number of direct quotations from such sources. However, there is a problem – not only are these sources rather obscure, but their reliability as material upon which to build a theory is highly questionable.

Many of the so-called "medical" sources, such as, The Ladies Guide, [1904]; Jack's Reference Book, [1908]; The Doctor at Home, [1910]; Ruddock's Homoeopathic Vade Mecum, [1914]; The Modern Family Doctor, [1928]; and, The Nervous Child, [1930], were obviously designed for domestic use. Even worse, very few of the old medical ideas of such publications have survived.

Even one as "recent" as 1944, the Textbook of Obstetrics and Gynaecology would now be almost completely redundant, since it predates most of our modern ideas of medicine. In 1944, penicillin remained relatively unavailable to the general public, while modern medications, especially psychiatric medications, as well as the new technology such as ultrasound, and modern computerized exploratory equipment, had yet to be developed.

There are also major problems in comparing health problems in different eras. Despite the best statistical material we cannot really hope to know how endemic were the effects of the past environment. Ordinary folk lived amid a cesspool of environmental pollution; materials now known to be extremely noxious were commonly present in their daily life. Chemical waste went straight into the rivers which supplied their drinking water; they worked in factories totally unprotected from chemicals and other deleterious materials. They lived in cramped, damp houses, and the streets, where their children played, were flowing with industrial discharges.

Starvation and malnutrition was rife, their food was of poor nutritional quality, and deficiency diseases such as rickets were endemic. Even the wealthy lived in conditions which would be not be tolerated by modern health authorities. While we do not know how much illness can be attributed to such conditions, we do know that since the environment has improved many of the diseases which the author attributes to hypochondria have almost disappeared.

The author is rather fixed in his attitude perceiving the "…downward pressure on all the internal organs…" [p. 31] from poor posture and constrictive clothing as the ultimate cause of physical health disorders. To this end he seeks clues in the most abstruse locations, even seeing evidence in various pictures and illustrations – an extremely suspect method of diagnosis. He suggests that the stooped posture of Darwin, "…was the cause of his health problems." [p. 102], and that a portrait of Howard Hughes indicates "curvature of the spine." [p. 242]. In a drawing of the Hospital of Salpêtrière, several pedestrians can be seen walking on sticks and crutches, and he concludes they are that way because "…the corsets crippled their spines and bodies." [p. 137].

The fact that they may have had other ambulatory disorders is conveniently overlooked. The Salpêtrière housed a wide range of patients including those with broken limbs, and one must ask, could broken legs be caused by tight corsets?

Likewise, in the well known painting Le Lecon clinique du Dr. Charcot1 where Charcot is shown holding an unconscious woman, the author concludes, that the woman was wearing a corset and attributes her condition to fainting, caused by compression of her abdomen, [p. 136]. He ignores the fact that this woman was apparently one of a small number of female hysterics, residents of Salpêtrière, whom Charcot, at that stage of his career, used in his lectures to "prove" his theory that only hysterics could be hypnotized.

Unfortunately, not only was his theory wrong, but his research was seriously flawed. He had too small a sample (3 patients), and Charcot himself never hypnotized these female subjects. This was done by assistants, who aware of Charcot's theories often "prepared" these subjects to respond as they thought he would want them to perform2. Not only that, but, believing hypnotized patients were "unconscious" and unable to hear anything, Charcot freely discussed his ideas in front of the patients, not realizing that they heard every word he said. How much they were influenced to act out his ideas we can only guess.

While much of the hysteria displayed by Charcot's patients was probably genuine, it appears very likely that there was also considerable "acting". These patients may have been deranged but they were not stupid; they had a gullible audience of medical students, and since they were expected to "perform" no doubt they probably did so. The better the performance the more attention they received from doctors and staff, in their own way they were "celebrities" and they probably received other forms of rewards. Corsets had nothing to do with the phenomena.

Naturally, all these problems made Charcot's work totally invalid. As a result, when the author mentions that a number of authors had noted that by the early 20th century the more severe forms of hysteria which Charcot had frequently witnessed no longer existed, and he attributes this problem to the restrictive corsets of the 19th century which by then were no longer in fashion, [p. 137], his argument is invalid since it is based upon a series of false assumptions.

Furthermore, such claims completely ignore the complex issues relating to what were "normal" levels of social hysteria. Over the centuries humankind has experienced many forms of collective hysteria. In the collective hysteria that swept Europe in the forms of the dancing-manias and witchcraft, hundreds of thousands fell victim to hysteria. We can now appreciate that there were powerful social and cultural elements in such episodes. Indeed the author even alludes to social factors being a contributory aspect when he mentions that 19th century observers themselves noted that the incidence of hysteria was greater amongst English women than it was amongst French women, [p. 156]. Perhaps there was, and remains, a French preoccupation with hysteria; interestingly, while, French psychoanalysis has remained faithful to hysteria over the years…the subject hardly features at all in the English language journals.3

Much of this behaviour was related to "social-expectations." Thus fainting, once a very acceptable female behavioural trait, could only exist in a society which believed that women were frail, easily perturbed, creatures. Yet fainting was restricted to certain classes. It was rare amongst ordinary working women, they had no time for such nonsense, and besides, they could be sacked if they fainted at work. Likewise, amongst dominant women, like Florence Nightingale and Emily Pankhurst, who refused to conform to accepted social criteria, it was unknown. One only has to compare the widespread frequency of females fainting in the 19th century with its rarity amongst modern women to see that powerful social factors underlie such behaviour.

Such is the level of the author's dogmatism that he repeats the rather absurd claim, put forward by John Bulwer in his book, Anthropometamorphosis, [1650], that women who wear tight corsets "…open a door to Consumptions and a withering rottenesse." [p. 510]. This author rationalises that such practices "crushed the bowel" [p. 425], making one susceptible to infections such as TB and typhoid. Yet, the fact is, once the bacteria which caused typhoid was identified, and health authorities treated the water supplies, typhoid almost disappeared! Similarly, despite changes in clothing styles in the 20th century, TB continued to be a health problem until medicines were developed to control it. The fact that it is re-emerging probably has more to do with poor standards of health than tight jeans.

The section on shell-shock I considered superfluous. It dealt with the subject too superficially. The author's claims that such trauma was primarily attributable to "shockwaves," [p. 324], and that contributing factors were the soldiers' "… thin chest, tight clothing, heavy knapsack and unaccustomed effort…" [p. 328] are incredible. The author completely overlooks the psychological factors, the mental stresses, the fear and frustration which would have contributed to the disorder. Not everyone can withstand the intense physical and mental demands placed upon a soldier in a combat situation. The term "shell-shock" which was introduced when the problem was little understood, and simply attributed the problem to percussion, is outmoded, the term "combat fatigue" is a much more appropriate description of this health problem.

Overall, while I found this an interesting book I believe that the author has erred in attempting to attribute every physical disorder to the physical aspects of visceroptosis. His conclusion that psychological factors make no contribution to such disorders is speculative. His claim that, …there has never been a satisfactory way of explaining how an emotional disturbance could cause the range of symptoms. [p. 97], is inherently correct, but there is a vast range of research literature which demonstrates some form of causal connections.

One should never forget that for many decades the relationship between smoking and the incidence of cancer was widely accepted, yet there was no actual physical evidence. That had to wait until improved scientific methods could demonstrate the physiological processes involved. Likewise, stress from a wide range of sources is an integral part of all human life. Its manifestations, in many forms of the so-called "neuroses" closely parallel the various symptoms of hypochondria and hysteria.

I have little doubt that visceroptosis may cause malformations but, as medical records show, humans are remarkable adaptable, they can adapt their bodies to the most incredible conditions. On that basis it would seem rather likely that in most examples of visceroptosis our internal organs, which are remarkably supple, would simply adapt and continue to function normally.

If anything the book serves to show the credulity of humans in their willingness to accept clothing styles which are not simply uncomfortable, but often dangerous to health. Unfortunately, fashion appears to remain beyond the realms of common sense, and considerations such as whether clothing is comfortable or restrictive continue to be ignored as individuals follow peer-group pressure as the principal factor in what styles of fashion they adopt.

1    Literally Dr. Charcot's clinical lecture.
2    Sheehan, P.W. and Perry, C.W. (1976). Historical antecedents and perspectives. In P. W. Sheehan and C. W. Perry, Methodologies of Hypnosis: A Critical Appraisal of Contemporary Paradigms of Hypnosis. Hillsdale, New Jersey: Lawrence Erlbaum Associates, Publishers.
3    Halberstadt-Freud, K. C. (1996) Studies on hysteria one hundred years on: A century of psychoanalysis. International Journal of Psycho-Analysis, 77, 983-996, p. 990.

Reviewed by L. Eddie, 2nd February 1998.

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