www.msmagazine.com/Summer2008/pathologizingyourperiod.asp
Pathologizing Your Period
Despite a lack of evidence, the psychiatric establishment has
made
extreme premenstrual distress a recognized disorder—and a boon to Big
Pharma.
By Paula J. Caplan
Are you unhappy? Bloated? Is it hard to concentrate? Do you have food
cravings? Breast tenderness?
If you read the Diagnostic and Statistical Manual of Mental Disorders
(DSM), published by the American Psychiatric Association, you will find
your symptoms listed under “premenstrual dysphoric disorder” (PMDD). In
other words, because of those symptoms, a therapist or doctor could
label you as having a mental disorder.
The DSM is the bible of psychiatric diagnosis, used by nearly every
hospital, clinic, doctor and insurance company, as well as Medicare and
Medicaid. Since PMDD first was mentioned in the DSM in 1987, people
have received the mistaken impression that it’s real and that it’s a
mental illness. With the manual’s fifth edition currently in
preparation, that notion seems likely to be strengthened rather than
discouraged.
Contrary to popular opinion, the creation and use of psychiatric
categories is rarely based on solid science, as I learned when I served
on two DSM committees. The absence of science leaves a void into which
every conceivable kind of bias has been found to flow—including sexism.
The DSM’s own PMDD committee reviewed more than 500 studies for the
1994 edi
tion and concluded that no high-quality research supported the
existence of PMDD, yet PMDD was placed in the manual anyway.
Do some women report feeling worse before their periods than at other
times of the month? Certainly, although in some countries and cultures
more than others. Premenstrual discomforts are also more often reported
by women who were sexually abused as children, are struggling with
abuse or harassment, or are just plain overburdened. But that is worlds
away from a mental illness.
Two powerful DSM authors proposed adding PMDD in the mid-1980s and
proposed adding it to the next edition of the manual. It would
represent an extreme form of PMS—the popularly accepted “syndrome” of
physical and emotional symptoms between ovulation and menstruation. To
qualify, it would have to include five familiar PMS-type symptoms, at
least one of them a “mood disorder” such as feeling hopeless, “on
edge,” self-deprecating, irritable, angry or tearful. No one keeps
comprehensive records of how often a PMDD diagnosis is given, but based
on PMDD committee estimates, approximately half a million American
women could be given the PMDD label.
Hundreds of researchers have tried unsuccessfully to prove that women
are more likely to have mood problems premenstrually than at other
times. University of British Columbia researcher Christine Hitchcock
says, “Something like half of women say they hav
e premenstrual
problems, but when you ask them to keep daily ratings of their moods,
the data don’t reflect that.” Another study showed that men identified
PMDD symptoms in themselves as commonly as women did.
Despite this, when Eli Lilly and Company's patent on antidepressant
Prozac was about to expire, the pharmaceutical giant successfully asked
the Food and Drug Administration to approve it to treat PMDD, providing
a patent extension worth millions. Eli Lilly repackaged Prozac in pink
and purple and rechristened it the feminine-sounding “Sarafem.” Other
drug companies rushed to market similar products. They deliberately
listed physical problems associated with menstruation for some women,
such as breast tenderness or bloating, and added a list of mood
problems from the PMDD list that virtually every human being
experiences.
The PMDD mood symptoms are also listed for menopause, although they are
supposedly caused at menopause by deficiency in the hormones whose
increasesupposedly causes PMDD. I half-jokingly predicted that we would
soon hear about premenarcheal dysphoric disorder between a baby girl’s
birth and her first period, thus pathologizing women’s moods from birth
to death.
Women should be wary of believing claims that high-tech research has
now proven that PMDD is real. We should also advocate a national
conversation—even congressional hearings—about the often hidden,
devastating20consequences of simply being given diagnostic labels such
as PMDD. Finally, we should stop pathologizing ourselves and other
women and help each other look at what’s really behind our feelings.
The full text of this article appears in the Summer issue of Ms.
magazine, available on newsstands or by joining the Ms. community at
www.msmagazine.com.
PAULA J. CAPLAN, Ph.D., is a clinical and research psychologist,
currently a nonresident fellow at the DuBois Institute,
HarvardUniversity. She is author of They Say You’re Crazy: How the
World’s Most Powerful Psychiatrists Decide Who’s Normal (Da Capo Press,
1996).
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