Monthly madness

A group of American psychiatrists have proclaimed that some women suffer from a mental illness that usually begins a week before their menstrual period.

Published: Friday 15 October 1993

-- FOR MANY a woman, the prelude to her menstrual period is depressing -- she suffers from a strange melancholy, marked by symptoms like anxiety, petulance and lack of concentration.

Until recently, all such symptoms -- 150 in all -- were clubbed under the term premenstrual syndrome (PMS), but no single treatment was available. Now, the American Psychiatric Association (APA) has proclaimed that a few women, with severe symptoms, actually suffer from a mental illness that the APA has termed premenstrual dysphoric disorder (PMDD). "We believe this will result in better health care for women and reduce the suffering of women with this disorder," notes APA (New Scientist, Vol 139, No 1884).

The diagnostic criteria the APA has drawn up to detect PMDD focus on mood changes severe enough to lead to "functional impairment" where a woman suffers from a disturbance that "markedly interferes" with work, education or social relationships. Welcoming the APA decision, some psychiatrists contend it is essential to define an ailment precisely so that treatment can be prescribed. The APA estimates that 5 per cent of American women of reproductive age suffer from PMDD and may need psychiatric help.

The debate revolves around two ways of looking at the problem. The first -- the biopsychosocial model of mental illness -- emphasises the role of social and cultural influences in the development of mental illness. The rival view, called the medical model, is based on a person's behaviour.

Defending APA's decision, Robert Spitzer of the New York State Psychiatric Institute says, "This would minimise the clinically inaccurate use of the term 'PMS' and the consequent underdiagnosis, overdiagnosis and misdiagnosis that have prevented optimal assessment and clinical care."

But the biopsychosocial model supporters are up in arms against the APA decision. Says Paula Caplan, a psychologist at the University of Toronto, "This is a classic example of bad science motivated by financial incentives and anti-feminist ideology." Furthermore, fears have been expressed in USA that lawyers might use the diagnosis in court as a weapon against women in child custody battles.

Against women
Such diagnoses can be a powerful way of "dismissing women who are assertive in the workplace or unhappy at home -- a way of not hearing what women are saying", argues Jane Ussher, a clinical psychologist at University College London. Partners or work colleagues can trivialise a woman's feelings by saying, "It's just your hormones, dear."

Despite the focus on hormones, PMS has no established biological or psychological cause. Women's premenstrual experiences seem to be intimately related to their social, psychological, cultural and economic circumstances. While not denying the reality of women's experiences, Caplan who supports the biopsychosocial model says, "But good research indicates that women who suffer most premenstrually are more likely to be in upsetting life situations. They are not mentally ill... They need help to change their social and physical environment."

And adds Ussher, "Women ought to be able to receive help without having to receive a diagnosis implicitly tied to biology. PMS may be a vehicle for women to express real unhappiness that is not necessarily caused by the menstrual cycle."

Curiously, men, too, suffer cyclical changes in moods, but their abnormal condition was never attributed to biology. Medically-based psychiatric diagnoses can be dangerous in practice, argues Ussher, and adds, "Women are being given drugs with often serious side-effects for the problem."

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