Well, what a relief! PMS now recognized as mental illness


August 03, 1993|By SUSAN REIMER

It was years ago, when those of us who spoke of premenstrual syndrome were on the cutting edge of New Wave feminist topics, and I was trying to explain this curse to a male friend.

"We are not talking about water-retention and mild irritability here," I said. "We are talking about volcanic rage sandwiched between bouts of helpless weeping and episodes of timidity so severe that driving a car takes more assertiveness than you can muster. And these feelings come and go with the cyclical precision of the tides.

"I have three sisters, and one can tell of mood swings wilder than the other. This is real, but it can't be normal."

He paused to consider. "Are you sure y'all aren't just bitches?" he asked.

Years later, the American Psychiatric Association has provided me with my snappy comeback. We're not bitches. We're mentally ill.

Great. Hey, what a relief. And all this time, I thought I was just an inadequate person, that I was suffering from an acute case of failure-to-cope.

Instead, I learn that I am not just the victim of poisonous hormone surges that flood the real me right out the door. I have a "depressive disorder."

The soon-to-be published edition of the APA's Diagnostic and Statistical Manual of Mental Disorders refers to severe forms of PMS as "premenstrual dysphoric disorder" or PMDD. It is described as "a pattern of severe, recurrent symptoms of depression and other negative mood states, that occurs in the last week of the menstrual cycle and markedly interferes with daily living." No kidding.

This definition, and the decision to classify it as a mental illness, was arrived at after five years of discussion by an APA study group. But even the members of the study group could not agree among themselves that PMDD should be so classified. They could not agree on the symptoms, the cause or the treatment.

And for a woman, coming to terms with PMDD is just as difficult.

Where does a woman start when the volume of her anger makes her ears ring? When she finds herself standing outside herself, watching someone she doesn't recognize, but is powerless to comfort or to calm?

Is this a behavioral problem, a function of the kinds of pressures women are under, or is it chemically induced? Is there some receptor in the brain that, for some reason, becomes more or less responsive to the ebb and flow of estrogen during a woman's cycle? No one knows.

Women are loath to mention it, except in exchanges of black humor with friends. It sounds too much like the old alibi, "Don't mind me, I have my period." We stopped using that excuse when we stopped using Harriet Nelson and Donna Reed as role models.

The APA estimates that only 3 percent of women suffer from PMDD. What a coincidence. They all live near me.

A physician friend once mused that if she asked every woman on whom she performed routine gynecological examinations if she was experiencing anything that might fit the description of PMDD, "I bet I'd be blown away by the response."

There are more than 150 symptoms assigned to PMDD, and a woman can spend a lot of time flogging herself for failings in her character before she looks at her calendar and sees a pattern.

What happens when she mentions these vague -- and face it, bitchy -- symptoms to her doctor? The range of treatments only illustrates how little is known about this malady.

Avoid caffeine and alcohol. Take anti-depressants. Go on The Pill. Take vitamin B-6. Take magnesium. Eat pasta. Take estrogen or take progesterone. Don't skip meals, avoid junk food. Join a support group. Pamper yourself with naps and romance novels. See a therapist.

A British doctor and well-known author on health topics, Caroline Shreeve, advised women sufferers not to drive, ride a bicycle or PTC attend important meetings during this time in their cycle. She also wrote that women should wear dark glasses, use worry beads and reserve a special outfit for PMS days. "Try to avoid black -- it's far too funereal," is her advice.

Does it sound like we are guessing here? Why not add: Have a hysterectomy. Take a lover. Join Club Med. Try yoga. See an acupuncturist, see a hypnotist. Buy yourself something pretty.

Considering what we don't know about PMS, they all make about as much sense.

A depressive disorder? You bet women get depressed. You'd be depressed, too, if you felt like this and the only explanations you have are: You're a bitch or you're crazy.

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