Disease has not come upon you because you have been attacked by a germ of some kind, it has not come because you have breathed some extraordinary microbe, it has appeared because you are ready for it, in most cases because you have deserved it as a penalty for violating Nature’s health laws.
– Bernarr Macfadden, Encyclopedia of Physical Culture, 1911
This 1911 quote from American health promoter Bernarr Macfadden has an eerie ring to it in 2022. It mirrors a common theme in alternative health COVID denialism: that a microbial pathogen can’t make you sick, only YOU can make yourself sick with pathogenic behaviours.
An example is the 2020 book The Contagion Myth, which questions germ theory in relation to COVID and was written by Thomas Cowan, a physician who gave up his medical licence. The book also enjoyed promotion from popular “holistic psychiatrist” Kelly Brogan, who runs an online subscription group in which paying members learn about coming off psychiatric medication through a regimen of paleo-style eating, coffee enemas and yoga. Shortly after the onset of the pandemic, Brogan began posting pseudoscientific conspiracy theories verging on germ denialism. Both Cowan and Brogan sell a theory of illness similar to Macfadden’s: that all disease stems from poor lifestyle and can be corrected with enough discipline.
Macfadden (1868-1955) isn’t a household name today, but he was famous in his time and had enormous influence on the development of modern wellness culture, a lifestyle-focused alternative health movement predominantly found in the West. Wellness culture has been implicated in the current “infodemic,” defined by the World Health Organization as “false or misleading information in digital and physical environments during a disease outbreak.” Macfadden’s legacy includes his contribution to our infodemic, both in his conception of what “health” is and in his enormous success selling a glossy celebration of that idea.
Bernarr Macfadden, the 20th century’s first celebrity health influencer
Macfadden launched Physical Culture magazine in 1899, a collection of articles on health advice (mainly written by him) and photos of scantily clad figures exercising enthusiastically (often including him). The magazine was an instant hit and Macfadden capitalized to build it into a New York-based publishing empire, becoming widely celebrated as an avid (if eccentric) promoter of health.
The images in Physical Culture were meant to be motivational, which was sometimes nodded to directly, such as in the 1919 cover showing a man flexing his arm while looking in a mirror and seeing a more muscular version of himself looking back. The text below the magazine title reads “Put On 25 Pounds of Health,” illustrating Macfadden’s bedrock belief that a muscular physique was the ultimate expression of health.
On the cover of a 1939 issue, a slim and smiling blonde woman emerges from the shadow of a fat woman, an image echoed in a modern-day fitspo (fitness inspiration) meme showing a muscular man trapped inside a cartoonishly large and gluttonous man. Much like an Instagram star posting fitness memes and workout photos, Macfadden intended his imagery to inspire a love of exercise, essentially making him the first fitspo influencer.
Physical beauty, or more specifically, early 20th century white America’s notion of beauty, was glorified in the pages of Physical Culture as the reward for healthy living. This was a core part of what the magazine sold: aspirational imagery of narrow beauty ideals alongside a fitness regimen and health promises. Certainly, Macfadden wasn’t the first charismatic showman making grandiose claims to sell a fad diet, but he connected the pursuit of health to pop culture and media in a way that was new and powerful.
Macfadden was a prolific writer of more than 100 self-help books (with titles such as Physical Culture for Babies and Vitality Supreme) and considered it his life’s mission to spread his gospel of health: a regimen of fasting, fitness and hostility to medical science. Some of Macfadden’s ideas were ahead of their time, like promoting exercise for women, but many were simply quackery, such as his staunch opposition to vaccines and his belief that fasting was a cure-all.
The cover of Physical Culture habitually featured the words “weakness a crime, don’t be a criminal,” which is to some degree a neat encapsulation of Macfadden’s worldview, that “a person could exercise unqualified control over virtually all types of disease,” if that person had sufficient willpower to live correctly. For him, any sort of physical weakness was self-inflicted and indicative of poor character. In 1940, Macfadden proposed granting Americans who had attained “physical perfection” extra votes, opining that “there should be no question as to the value of such a plan” to improve democracy. His ideology quite literally devalued people who didn’t fit a physical ideal.
The cover of Physical Culture habitually featured the words “weakness a crime, don’t be a criminal.”
The origins of wellness culture and the modern health consumer
While Macfadden was one of the most prominent figures in physical culture, the movement preceded him. Its earliest origins lie in a mid-19th century German and Swiss movement called Lebensreform (life reform), whose adherents saw illness as stemming from modernity’s excesses and advocated a return to nature. The movement was in large part a reaction to urbanization in the Industrial Era and its subsequent ecological, social and political impacts.
Central to Lebensreform was returning to a purer, less modern lifestyle, one without processed foods like refined sugar or flour, without vices like alcohol or tobacco, and with plenty of exposure to fresh country air, far away from the choking smog of the cities. Lebensreform taught that restoring health meant rediscovering the customs and lifestyle of an idyllic agrarian past, an early version of the ancestral diet model that we commonly see[MC5] in wellness today. In the early 20th century, German immigrants brought Lebensreform ideas to California, opening its first health food stores and inspiring a generation of “Nature Boys” who would go on to influence the counterculture movements of the 1950s and 1960s.
The term “wellness” as a health concept originated in the mid 20th century, referring to the attainment of optimal well-being and functioning. In the 1970s, it was adopted by alternative health practitioners to differentiate from what they called the “illness” or “disease” model of medicine. This was on the heels of the counterculture movement, which heavily critiqued the paternalistic and profoundly biased Western medical establishment. Alongside these anti-establishment attitudes came an increased interest in non-Western and pre-20th century medical traditions.
The 1960s was also a turning point in the development of a consumerist health-care system, one in which patients had more autonomy but primarily within a capitalist framework – the emphasis being liberty to choose amongst a set of health-care purchases. Neoliberalism in the late 20th century further developed the notion of personal choice, and therefore responsibility, in health, freeing the state from culpability for health outcomes as public resources declined.
Wellness culture’s ideology of self-determination fits easily within a neoliberal model of health care. A core aspect of Lebensreform that was also central to Macfadden’s philosophy is the absolute ability of individuals to shape their own health. The role that social forces, genetic factors or simply luck play in an individual’s health are minimized to enlarge the impact of virtuous behaviours like exercise or avoiding processed foods.
This attitude can also be called “health libertarianism” and places heavy focus on individuals to shape their own physical and psychological well-being, such as when Brogan counsels her followers that abandoning “victim narratives” (like poverty or childhood abuse) are crucial to attaining optimal health. Key to Brogan’s stated goals is freeing health from “daddy government and mommy medicine” to reclaim humanity’s “natural” state of sovereignty and self-determination.
Health consumerism in the wellness context adds a new type of virtuous behaviour: buying the right product or service. In Brogan’s world, health is bought via $1000 memberships to a program she calls “Vital Mind Reset.” The wellness prophet always has a book or a supplement to sell, and in a society that expects health to be at least in part a shopping experience, selling well-being in a bottle is normalized by the redefinition of health as consumer choice.
Of course, 21st century life involves daily bombardment with messages about what to buy to live better: to be happier, more successful, more attractive. When Goop blended aspirational marketing with a beauty and celebrity-driven version of wellness, it found a lucrative niche. Indeed, alternative health practitioners commonly sell beauty services and beauty products alongside wellness claims. With Physical Culture’s appearance on the newsstand and glossy images of narrow beauty ideals popularized as a visual shorthand for health, wellness culture and beauty culture fused together in the modern imagination.
Wellness culture’s media and the infodemic
The 21st century media ecosystem has contributed significantly to the rise of health misinformation, both by being a vehicle for celebrity lifestyle influencers to promote themselves and by allowing news organizations to uncritically report on poorly evidenced medical therapies, sometimes called “implicit hype.” Added to this is the advent of highly polarized online communities as well as the rise of the social media lifestyle influencer, which has dramatically increased the ability of health misinformation to spread online.
COVID-19 has provided many direct demonstrations of infodemic distortion of science. Comedian Joe Rogan’s popular podcast draws a massive audience who follow his musings on health and fitness alongside his hearty endorsement of the supplement brands that sponsor him. During the pandemic, he has lent his sizable platform to prominent figures opposed to public health measures, like Pierre Kory, Alex Berenson and Peter McCullough. Often these guests seek to promote discredited treatments like hydroxychloroquine or ivermectin, and Rogan himself publicly spoke about his own experience taking alternative therapies for COVID-19.
Rogan’s celebrity and knack for podcasting is what built his audience, and therefore his influence. He has no relevant scientific or medical background to inform his health advice, and yet primarily on the basis of his own muscular appearance, he regularly gives fitness and lifestyle advice. Celebrity influencers like Rogan and Gwyneth Paltrow owe a debt to Macfadden for popularizing a self-determined and beauty-focused concept of health, a prize to be attained through virtuous behaviours and visibly demonstrated to the world as a lean, muscular body. He paved the road between alternative health, with its anti-establishment tendencies, and America’s burgeoning entertainment and media industries, obsessed with a certain type of beauty.
The throughline between today’s wellness culture and 1899, when Macfadden published his first issue of Physical Culture, is the view that complete health sovereignty can be achieved by rejecting modern medicine in favour of traditional wisdom and virtuous behaviours; and that the reward for healthy living is physical perfection. Alongside an increasingly consumerist health-care system based on neoliberal values of personal responsibility through healthy purchases, wellness blossomed into a multi-billion dollar global industry. And with the outbreak of COVID-19 in a political and media landscape driven by outrage and plagued by misinformation, it’s inevitable that the denialist and anti-vaccine voices primed to reject the public health establishment would lean into Macfadden’s vision of health sovereignty.
Recognizing historical influences is just the start of tackling the social underpinnings of the infodemic. Going forward, we should directly interrogate the individualist and moralistic notions of health that permeate Western society and have proven to be a cultural barrier to public health measures. We should also deconstruct our biases around beauty, race, body size, gender and ability and honestly examine how these biases inform our notions of health.
Before we face the next pandemic, we must shed the legacy of the idea that a sick person “deserved it as a penalty for violating Nature’s health laws.” Our capacity to care for one another as a society through a health crisis depends on it.