PMS Is Real

Some months, I feel the precise moment when the lights go out. One second, there is goodness in the world; in the next, it vanishes. Other months, the clouds descend gradually, till happiness is just a muted haze.

The months when I can feel a muffled happiness are the good ones. Joy reaches me bundled in cotton, but at least it’s there. Having appropriate emotional responses is as hard as moving through treacle, but at least I can move. Sometimes I only remember what time of month it is when I find myself surprised at how hard joy has turned. The light is glowing on the chestnut branches, a friend’s eyes are glittering — but inside me, there is only a flicker.

Sometimes it’s not cotton, but glass between me and the good world. I see the chestnut and the friend clearly — but I’m on the other side, and though the glass is invisible, I can’t get through. Other times, everything loses its glow. The trees which ordinarily call out “Go for a walk!,” the books which say “Read me!,” the problems asking to be solved all go mute. I can’t find my happiness — I can’t even find my wanting. My hands and face go numb along with my mind.

Clinically, this is called “dysphoria.” This is precisely what it sounds like: euphoria with a minus sign. An unshakable sense that all’s bad with the world. Free-floating despair. Etymologically, it means “hard-to-bear-ness,” and that’s exactly how it feels: Everything is too heavy.

I try to tell myself there is nothing to be sad about. My voice tumbles down the precipice, fading away without ever reaching the bottom. Ordinary sadness, even moderate depression, can be talked to; PMS doesn’t speak the language. The usual links between thought, feeling, and action all seem to have snapped.

I know all of this will go away by the time my period starts, and every ray of light on a chestnut will be a miracle again — but it doesn’t help much to know this. Imagine you found out — experienced in a viscerally felt flash — that everything was empty on the inside , even people. Would it help to know that a day — maybe a week — later you would forget what you had felt?

If I keep repeating, “Everything is okay,” I can hold onto the words — a spell keeping my own darkness at arm’s length. What I can’t do is feel the truth I’m holding; I don’t have the hormones with which to feel joy.

This is what PMS is like for me.

It’s not about men
Skies dusking a desperate black isn’t exactly the first image that pops to mind when you hear “PMS.” An irritable woman engaging in “ear-splitting yelling, irrational arguments and fits of tears” is a little more familiar.

Moodiness and irritability (and fits of tears, too) are certainly part of my PMS experience. A few cycles back I entered a favorite coffee shop at 11:45 a.m., hoping to order a quiche. The barista told me they didn’t serve items off their lunch menu till noon. I snapped something at her, backed away from the counter, and felt the world collapsing beneath me. I was starving and powerless. I had nowhere to turn. Unbearable possibilities were closing in around me: waiting for 15 minutes, deciding on another place, finding an item off the breakfast menu. All felt desperately beyond me.

Another time, on a holiday together, my boyfriend asked me if I was planning to brush my teeth before leaving the hotel. I snapped something along the lines of, “Don’t tell me what to do!”

A woman’s “irritability” is how men experience PMS. Moodiness is the visible ripple on the surface of a woman’s suffering. I snap because all the goodness has gone out of the world and I’m scared. I snap because the soundtrack to everything is Shostakovich, and I can’t turn it off. I snap because I’ve been smiling for hours from a place unreachable by joy. I snap because I’m exhausted from trying not to snap all day.

On that holiday with my boyfriend, I snapped because my feelings heard, “You have bad breath and I wish I was on this holiday alone, and you’re just taking up space.” (Unlike the readers of “Handling Her Period Like a Man,” Ben cares about his girlfriend’s inner life, so when I explained myself, he made it abundantly clear that just taking up space couldn’t be further from the truth.) Was this irrational? Is it irrational to see a straight stick in water as bent? Is it irrational to miscalculate simple sums when you have a splitting headache? Is it irrational to shiver when you have a fever — even if it’s warm outside?

There is some evidence that women with severe forms of PMS (more precisely, PMDD; see below) perceive neutral faces as if they were faces expressing negative emotions. I think this happens to me — and I can’t turn this off, just like you can’t turn off that straight stick in water looking bent.

Society treats PMS as if it were a man’s problem. (More generally, society treats mental health problems as if they were problems only for those who don’t actually suffer from them.) If women got cold before their period, men would be complaining about their irrational shivering. If women’s eyesight got worse every month, society would be asking how we could stop them from rudely bumping into men.

Let me say it again: It’s not about men.

Enter PMDD
Huge caveat: I’m not a psychologist, and I have read very little of the primary literature on PMS/PMDD. I’m basing these general remarks on Wikipedia, and on the TEDx talk which I’ll discuss below. Based on my cursory glance at the literature, it’s also quite clear that I’m something of an outlier. Please bear this in mind, and take what follows with a grain of salt!

Over the last few decades, some scientists who call themselves feminists have noted the deficiencies of this male perspective on PMS, and argued that, to a great extent, women’s premenstrual irritability is caused by societal expectations about PMS. So far, so good. The problem is that these researchers then conclude that PMS doesn’t exist at all — it’s just a cultural myth.

In a TEDx talk titled “The good news about PMS,” which exemplifies this movement, psychologist Robyn Stein DeLuca presents research suggesting that while a genuine, serious disorder called “premenstrual dysphoric disorder” affects 3 to 8 percent of women, everyone else’s “symptoms” amount to culturally induced autosuggestion.

As you may have guessed, I (probably) satisfy the diagnostic criteria for PMDD. If DeLuca is right, my story is irrelevant to the vast majority of women. I’ll try to argue that this isn’t so — that there is an important continuity between PMS and PMDD, and denying this amounts to adopting the male perspective on PMS — but this argument will be largely speculative, and won’t directly question the scientific evidence DeLuca provides. In fact, some of this evidence has convinced me that there really are women who think they suffer from PMS but in fact do not. So — be warned, and judge for yourself.

But first, I want to make a point which stands even if all the scientific evidence is exactly like DeLuca paints it. In “The good news about PMS,” who is the news good for? The women with moderate symptoms who thought they suffered from PMS but are now being told they don’t? Is it good news for them that “science tells them” that they’re making their moods up? What about the 3 to 8 percent of women who actually suffer from PMDD?

That is by no means a negligible number of women. For comparison, the lifetime prevalence of depression is 8 to 12 percent. Some 5 to 10 percent of men under 40 suffer from erectile dysfunction. Can you imagine a TED talk called “The good news about depression: You’re making it up”? Or: “The good news about ED: You’re just not trying hard enough”?

And it’s not just the prevalence — PMDD is a serious condition. Deadly, in fact: According to some estimates, 15 percent of women with PMDD attempt suicide.

Good news my ass.

Harder to study — but not unreal
I do share DeLuca’s resistance to the medicalization of PMS. If the aim of diagnosing PMDD is to stuff the sufferer with poorly understood pharmaceuticals, then we’d better limit the diagnosis to those who really can’t be helped in any other way. But we shouldn’t forget that this is an artificial cordoning off of those who have it worst. To call the low prevalence of PMDD “good news” is to succumb to medicalization: It’s to accept that only those who are “disordered” suffer. It’s to accept a binary scale on which someone with five of 11 prespecified symptoms is diseased, but someone with four doesn’t have the right to complain.

Similarly, if we’re trying to rigorously study a psychological condition, it makes sense to start with stringent, well-defined, and testable criteria. This is why the evidence on PMDD is so much less equivocal than the evidence on PMS: PMDD was defined to be more easily studied! Concluding that PMS doesn’t exist is a bit like concluding that fermions don’t exist outside of laboratory conditions, since we haven’t quite been able to observe them there.

DeLuca uses the fact that there are hundreds of PMS symptoms as evidence against its reality. This is puzzling: You might think each symptom is evidence of PMS, and the number of symptoms is evidence of PMS’s seriousness!

Of course, I’m being unfair. Imagine a magician telling you that every time he shuffles a deck of cards, something “magical” will happen. And each time, something does happen: Sometimes pigeons fly out of the deck, and sometimes he smiles a smile somewhat different from the smiles you’re used to. You’d be right to complain: What’s so magical about a smile?! DeLuca’s contention is that PMS is like this: Women claim to be experiencing a special sort of magic each month, but they can’t specify in advance what the magic trick will be — and some of the “tricks” turn out to be entirely ordinary human experiences.

This is a legitimate worry — but it’s one that applies equally to the study of many other psychological complaints. Psychology is full of baroque lists of symptoms which suggest that we aren’t carving nature at the joints yet. Some of the symptoms of PMS may be pseudo-symptoms, some are probably culturally conditioned, some are strongly affected by sufferer’s beliefs about mental health. (The latter two features — which apply across the board in psychology — don’t mean they aren’t real symptoms.) Psychologists just haven’t separated the wheat from the chaff yet — but that’s no reason to preemptively conclude that it’s all chaff.

DeLuca is right to complain that it’s extremely hard to study a syndrome with hundreds of symptoms, many of which are ordinary human experiences. Test for their disjunction, and you’ll find it present at many other points in a cycle. Test for individual symptoms, and they might be replaced by something entirely different the next time around (and not be present at all in the woman next door, who has other symptoms). There may also be subtle cancellation effects. For instance, crying is certainly one of my PMS symptoms, but I’m not at all sure that I cry more in the last week of my cycle than at other times. Some months PMS hits me with emptiness rather than tears, and at those times I fail to cry at things I would have cried at otherwise. Quite possibly, the two effects cancel each other out. The study of PMS requires some extremely subtle experimental design. But this is a problem for psychology — not a problem with women.

The myth of the PMS myth
DeLuca is also right that medicalization is dangerous. If there are PMS symptoms which affect 80 percent of women, they surely can’t amount to a syndrome — they’re just normal aspects of the female experience. The externally visible symptoms of PMS, like irritability, are overblown, and often amount to women merely submitting to cultural expectations. The emotional profile of the premenstrual phase is much more subtle than the culturally sanctioned “turning into witches” view.

But she goes troublingly wrong when she infers from the complex emotional profile of the premenstrual phase — and from the failure of third-personal, male categories like irritability to fully capture PMS — that PMS doesn’t exist at all. She goes wrong when she assumes that cultural causes of suffering invalidate the suffering.

DeLuca is also right that the belief in PMS-caused irritability can serve to discredit women. It can be an excuse not to take legitimate complaints seriously, dismissing them as groundless feelings. But denying the reality of PMS can also serve this purpose, by depriving us of the language to articulate what we’re feeling. If PMS isn’t real, then when I snap, I really am just being irrational. DeLuca’s viewers are quick to pick this up. Here’s the top comment on the YouTube video of the talk.

So… are we saying that when she acts like that she doesn’t have the excuse of PMS? Because… then that means she’s just being a jerk for no reason.
Thanks science.
However imperfect the stereotypical picture, it allows me to explain my (overre)actions. I can say, “I don’t really mean it; I’m PMS-ing.” I may be ridiculed, but at least I’m partially understood. I wish I could say instead, without incredulous stares, “I’m sorry I snapped — it’s the time of month when my soul and my hands both feel numb” — but it’s still better to have an imperfect language than to be mute.

We’re fed a myth about women turning into witches each month. In fact, women have rich emotional lives affected by scores of things, including, but certainly not limited to, their menstrual cycle. For some women, like me, the effect of cycle on emotion is particularly pronounced, and can range from slightly dampened spirits to utter hopelessness.

In a culture raised on myths, these are the cases which result in witch-sightings. DeLuca notices the myth — and proceeds to erase the woman along with the witch. I suggest that we part ways here, instead striving to retrain our eyes — and learning to see the suffering human behind the witch-mirage.

A few words about coping
I’m apprehensive about posting this. I’m tackling two taboo topics in one: mental health and the female experience, and I’m publicly sharing a personal story — anecdotal evidence — on top of that.

I don’t know if posting is worth the vulnerability, but I do know that in an ideal world, this wouldn’t be a vulnerable topic to begin with. I’m writing simply because I’m sick of keeping quiet.

PMS/PMDD is surprisingly hard to recognize in yourself. I’ve known since high school that I could get hopelessly sad the day before my period started. It was hard to miss: bawling my eyes out about nothing at all one day, blood the next. But I didn’t realize until recently — when I started using a cycle-tracking app — that my mood (and sleep, focus, and digestion) is consistently worse in the second half of my cycle. Until recently, I thought I “just got depressed” sometimes, and had no idea that only two out of the four weeks were ever bad. (If you ignore the fact that the start of the first “good” week usually features debilitating cramps.)

Knowledge of the patterns in my own moods has given me back the sense of control which PMDD takes away. I wish I’d known earlier. If PMS — the real PMS, not the irritability — weren’t such a taboo topic, I could have.

I’d like to end with a short list of coping strategies for PMS/PMDD. (They’re also helpful for depression, anxiety, and mood instability in general.)

I dismissed them earlier, but little words like, “It’s okay” and, “It will get better soon” really are a magic charm. You don’t need to feel their truth for them to help you to wait it out.
I also find it helpful to tell myself: “It’s okay not to be okay.” Darknesses have a tendency to get self-reflexive — if you can at least remove the outer layer of self-blame, you’re making progress.
Knowing that what you’re going through is PMS/PMDD — and that you’re not making it up — is super helpful. You might want to use a cycle-tracking app to help gain this knowledge. I use Clue, and I generally recommend it, though it’s not perfect. When tracking moods, it makes you decide whether you’re experiencing PMS or just sadness/sensitivity. It’s hard to know what to do if symptoms appear earlier in your cycle than usual! It also seems to assume that PMS happens in one continuous chunk each cycle.
This 15-minute yoga sequence is a lifesaver. In fact, it’s the single most effective resource I have for combating PMS. Unfortunately, the voiceover is super annoying (“shift your attitude towards gratitude”?!) — but you can always mute it, and the poses really work for me. I’m risking sounding entirely unscientific when I say this — I have no idea what the mechanism is — but this sequence reaches deeper into the darkness than words. I’ve cried tears of wholeness at the heart-opening part at 6:43, tears that bridged the gap between thought and feeling when words couldn’t.
If yoga isn’t your cup of tea, sometimes just focusing on your breathing (slowly, pausing before each new inhale) can lift the weight a tiny bit. Meditation can work too, though there’s the danger that it’ll push you even deeper inside your head. I find it helpful as a way of noticing just how many thoughts are lurking behind my mood — and, sometimes, converting the mood into something that can be talked to.
I’ll say it one more time, louder: A disorder that makes women turn into witches — or bitches — is a social construct. Hormonal fluctuations which dim your inner glow, on the other hand — that’s lived experience.