Premenstrual Woman: The Modern Invalid

by Dr. Helen Cohen. B. Eng., ND.

The upcoming Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) intends to list the premenstrual syndrome as a mental disease entity for the first time in psychiatric practice. This means that PMS will he defined in explicit terms as a disorder distinct from other mental and emotional maladies to enable professional diagnostic identification. The authors of the psychiatric "Bible" would attempt to paint an overall picture of symptoms and objective signs as unambiguously as possible, provide a differential diagnosis, review all available data on epidemiology (i.e. who gels it), speculate on etiology and pathogenesis (i.e. why they get it), and then they will suggest a treatment plan (drugs or psychotherapy). The presently available DMS-III mentions PMS only briefly as one of the "intermittent explosive disorders it does not treat it as a mental disease entity and does not speculate on its possible organic causes. The aforementioned proposal raised an outcry from the female authorities who obviously see it as a possible threat to a working woman as well as to a mother.

Is PMS, then, a serious mental disorder with an underlying hormonal imbalance that affects the brain chemistry or perhaps even genetically predetermined, or is it just a case of three-day blues and bloating? The arguments rage - a lot is at stake here. Since I myself do not suffer from any of the specifically "female troubles" but am very attuned to feminism, I have spent many long years trying to figure out the tantalizing mystery of PMS. Now that I am about halfway through figuring things out (I hope), I would like to phrase the question differently: "Is there such a thing as PMS at all?" In fact, is there such a thing as an inherently female illness, is there such a phenomenon as a human organism that is sick because of her sex, or rather a SICK GENDER all together. (I know what you are thinking about: hut what about ovarian cancer'? Well, what about testicular cancer then?)

Let's see what it is that this PMS is made out of. Approximately every lunar month the body of the female who is in that period of her life when her ovaries are active (she is fertile) goes through a process called menstruation. On the surface this is what sets us apart from males because they do not menstruate, know little about it, and often scared by it. In terms of physiology, the menstruation is no big deal in itself, as it only really exists in response to ovulation, which is an internal process, invisible as it is, but in essence is the very nature of fertility. Two major potent hormonal substances regulate the monthly cycle under the supervision of the brain (pituitary and hypothalamus), these are, estrogen and progesterone. As everything in our body is intimately interconnected, many more hormonal and other chemical substances constantly change their concentrations in relation to the pituitary hormones and estrogens; and one of the biochemicals implicated in making women "crazy" is brain neurotransmitter scrotonin. Others are steroids and prostaglandins that trigger pain and congestion of tissues by affecting small blood vessels and causing fluid retention and muscle spasm.

By the definition PMS is something wrong happening to a menstruating woman about a week or slightly longer before her period, when estrogen and progesterone levels reach their maximum. In reality, when a doctor is pressed to find the exact health history facts, as all homeopaths do during their consultations, one is often bewildered by simultaneously the complexity and vagueness of the actual complaints. Most of the women who decide, for one reason or the other, to trust their health into my hands for ANY (and I emphasize, any) health problem. believe that they suffer from moderate to severe PMS. When I insist on being specific to determine exactly when this dreadful thing descends on them, the answer is usually as follows: "What do you mean: "when does it start?" ... You know (and I assure them that I do not) .. Well, about a few days after the cramps (!!!) disappear ..." "When does it end then, as soon as the cramps start?" "No, it takes a couple of days for me to come down and unwind, to become myself again." ("myself' doubled in pain that is). As I usually insist on seeing my new patients on a regular biweekly basis until they are considerably better, rather than "take my medicine, do not antidote it, see you in six weeks" classical homeopathic treatment routine, it becomes further painfully obvious, not only to me hut to a woman as well, that she is hardly ever "PMS-free". The same is sadly true in the case of "premenstrual" migraines or "premenstrual" IBS (irritable bowel syndrome), or "prenienstrual" fibromyalgia (stiff neck), or "premenstrual' panic attacks, or "premenstrual" fatigue disorder. I am not implying malingering here, though. When I myself "came down" with mental and physical breakdown at the beginning of my motherhood many years ago, I thought that my fatigue, my anxiety attacks, my compulsive rituals were all much worse in the time before my period. I wanted to believe that, as it made things so much easier for me. It is true that many of us, when we ARE sick, experience worsening of our symptoms somewhere between the ovulation and the menses, probably partially due to the hormonal tides gone out of hand, but NEITHER OVULATION, NOR MENSTRUATION, NOR A POSSESSION OF THE SECOND X-CHROMOSOME CAUSE ANY OF THE MIGRAINES, DIARRHEAS, OR RAGE. For contrary to the prevailing medical opinion, that we as women innocently tend to support, being a woman is not a disease! My physical self can not cause my mental self to change, anymore than I can lift myself off the ground by my bootstraps. I am not two separate systems but one undivided whole, where everything is intimately and inseparably connected to everything else; rather it is something external to my organism that is the cause of all the suffering, both mental and physical. Hmmm, what could that be? Dare 1 say the dangerous, misogynous, threatening world outside my window? Am I having overwhelming anxious thoughts which I am trying to cope with through stupid rituals, such as doing everything three times, because my estrogen levels are rising too fast for me to handle, or because my teenage daughter is out there somewhere right now, all by herself, and the chances of something had happening to her are not influenced by my hormonal tides? Does the woman friend of mine, who is so talented and intelligent, so full of energy, periodically lash out at her gentle "supporting" (what a word!) husband or sparkling clean kids because her brain is malfunctioning? Does she feel out of control, angry, abandoned and frightened in spite of all the privileges of the "functional" middle class family because she is "premenstrual" or because she can't get anywhere in life, nowhere past the part-time professorship and no chance of publishing anything, but her ambitions and dreams are so overwhelming? Maybe she feels trapped from time to time because her creative energies have no exit out of her body but explode inside instead? And what about the countless young mothers who go back to work almost right after giving birth because they believe in the "quality time" but are completely ignorant of their own biological needs to nurture and bond? Why do they suffer such violent menstrual pain now, when they are not adolescents any more? Why do they catch every little cold their children bring home? "Undischarged excitement", "unlived lives" say Barry and Ann Utanov is the curse of the modern woman. (The Witch and the Clown, Chiron Publications 1987). "During PMS women feel "bitchy", writes Vicki Noble in Shakti Woman (Harper Collins 1991) "we are not able to go on being so self-sacrificing, squelching our instincts, quieting our actual responses." She continues: ""It is likely that, were we to regularly access our full menstrual power, we simply could not go on being nice girls. We might well reach a critical mass of raja and have to express it into our culture as revolution!"

So the key word here is ""menstrual" and the prefix is "pre" is there only for the purpose of camouflage and confusion. That bleeding creature (his majesty Dr. Freud said he could not figure out what she wants, besides the penis that is) she is simultaneously a headache and a source of income! Statistical estimates of the prevalence of PMS vary, but in recent years one would not be surprised to hear the numbers rise well above 50% of the entire female population. It looks like we are all sick, sister! Most of the time too. Sick, disturbed, moody, bloated, crabby, sexually unresponsive and in pain. Most importantly, we are in desperate need of professional supervision and intervention —medical and psychiatric! Does that ring a bell? Let's check out our health records. Let's look hack on our health history and our relationship with the medicine man.

In their well known book For Her Own Good: 150 Years of the Experts' Advice to Women (Anchor Press 1978) the authors Barbara Ehrenreich and Deirdre English put a new face on the relationship of women and allopathic medical doctors as the one type of experts that profit from treating a sick woman. The authors call the state of affairs invalidism, as in invalidism of the 19th century upper class woman, tightly hound in almost forty pounds of clothing, nipping vinegar and arsenic, advised to retire to bed every time she menstruated and expected to die in her prime. Medical authorities proclaimed her to he inherently ill from menarche to menopause. There were many different diagnoses for this condition: neurasthenia, dyspepsia, hyperesthesia the precursors of such modern maladies as chronic fatigue syndrome. Epstein-Barr virus, fibromyalgia, hypoglycemia, the formerly famous chronic candidiasis, and the currently fashionable co-dependency syndrome.

Well, what came from neurasthenia? Oh yes, hysteria of course. Such dreadful malady it was, the whole new profession was horn and challenged the physician and the surgeon for catering to the hysterical female, the analytical psychology that was. It was not enough to remove the clitoris or the uterus or prescribe drugs to cure hysteria, it was necessary to persuade a woman that the sexual abuse she thought she remembered, is only a fantasy caused by her penis envy and her infantile sexual aggression. And then the social order was once again as stable as ever; a woman had the comfort of professional opinion as well as the intangible physical diagnosis, so she stayed home and provided the infrastructure, grinding her teeth together to fight the dreams, the desires, the needs. "In the epidemic of hysteria", write Ehrenreich and English, ""women were both accepting their inherent "sickness" and finding a way to rebel against an intolerable social role. Sickness, having become a way of life, became a way of rebellion, and medical treatment, which had always had strong overtones of coercion, revealed itself as frankly and brutally repressive."

In almost twenty years since this hook was written nothing really changed, except there are so many more "health experts" competing on the market. Experts who are labouring to pacify tormented woman's soul through massage, counseling, yoga, meditation (let us learn from the East how to kill the feelings), natural this and holistic that, you name it. Turning the issues inside out and making it her INTERNAL PERSONAL problem that she is supposed to overcome on her own in total isolation, the very thing that makes her sick in the first place. Take care of your own "inner child" all by yourself and pay me for telling you to do so. There is a point of no return where I part with feminism. By fighting and challenging the medical and political establishment to reform and restructure the health care system from within to be more responsive to woman's health needs, by accepting such crumbs from the table as giving us back our midwife (on the condition she does what she is told), they are in fact inadvertently LEGITIMIZING this establishment and preventing it from collapsing under its own weight.

I saw a British television show about healers. One episode featured laying of hands as a treatment for infertility which failed to respond to the "conventional" methods. It was immediately successful and the couple had two healthy pregnancies. The healer was a grandmotherly woman who spoke kindly to her patient while doing something to her body. She appeared knowledgeable and wise. I do believe in laying of hands but even a hug, even a pat on the head from this wise healer would be therapeutic. This type of medicine cannot exist in North America; the production and sale of Valium and Xanax is a billion dollar industry. Psychiatrist Peter Breggin, M.D. in his book "Toxic Psychiatry" (Fontana 1993) writes: "Steinberg estimates that one in ten patients receiving Xanax will become addicted. Based on an estimated fifteen million people receiving Xanax each year in the United States, Steinberg concludes that 1.5 billion Xanax addicts are produced each year." The majority are women, of course! If PMS enters the Diagnostic Manual as a mental disorder, in all probability benzodiazepines, to which both Valium and Xanax belong, and whose long term use causes irreversible brain shrinkage among other things, will be recommended as drug treatment of choice.

Men have us, but who do we have to nurture our souls? Preachers and therapists. And we girls hate and tight each other every step of the way. Are we going to go for this PMS thing again? Haven't we learned anything? Do you think the day will come when on the first day of your period instead of going down to your "friendly neighbourhood" drug store to get some "extra strength" you, instead, will pay a visit to the neighbourhood women's bleeding circle to warm up by the friendly spiritual fire as well as to discuss some of your needs with the wise shaman on hand, maybe even to bury your head in her chest for a fraction of an aerobic class period? Will OHIP pay for that?

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