To begin, it’s important to establish a working and comprehensive understanding of what constitutes the diagnostic category of Premenstrual Dysphoric Disorder. The average percentage of people said to have PMDD is anywhere between 2 to 10 percent of the United States population (this includes some transgender and non-binary or gender-fluid folks). Taken from the National Center for Biotechnology Information, PMDD is defined as “a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins.”
The following are the most common symptoms of PMDD taken from the John Hopkin’s website:
- Lack of control
- Difficulty in concentrating
- Severe fatigue
- Poor self-image
- Emotional sensitivity
- Crying spells
- Trouble sleeping
- Swelling of the ankles, hands, and feet
- Periodic weight gain
- Diminished urine output
- Breast fullness and pain
- Vision changes
- Eye infection
- Abdominal cramps
- Pelvic heaviness or pressure
- Skin inflammation with itching
- Aggravation of other skin disorders, including cold sores
Neurologic and vascular symptoms
- Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs
- Easy bruising
- Heart palpitations
- Muscle spasms
- Decreased coordination
- Painful menstruation
- Diminished sex drive
- Appetite changes
- Food cravings
- Hot flashes
To think more about PMDD, I visited websites that readily appear in the google search, “What is PMDD?” One such site is the Gia Allemand Foundation. Their mission is to destigmatize PMDD, raise awareness, and provide educational support for those suffering with PMDD. The Gia Allemand Foundation’s site reads that
“While PMDD is directly connected to a woman’s menstrual cycle, it is not a hormone disorder. It is a suspected genetic disorder with symptoms often worsening over time and following reproductive events including menarche, ovulation, pregnancy, birth, miscarriage, and menopause. Women with PMDD are at an increased risk for postpartum depression and suicidal behavior. Many, but not all, women with PMDD have a history of sexual trauma or depression”
MedicineNet states that:
“Biologic, psychological, environmental, and social factors all seem to play a part in PMDD. It is important to note that PMDD is not the fault of the woman suffering from it or the result of a “weak” or unstable personality. It is also not something that is “all in the woman’s head”
Of course PMDD is not something “all in a woman’s head” but it is something that is partially in a person’s head, their body, and equally, part of the sociocultural (a combination of the social and cultural) environment which is external to, but assimilated into thinking and feeling states of, the body and a perception of self. This is a partial explanation of what can be referred to as naturecultural. Jussi Parikka describes the idea of naturecultures that comes from Feminist biologist and philosopher Donna Haraway in The Companion Species (2003) as a way to explicate:
“the necessary entanglement of the natural and the cultural, the bodily and the mind, the material and the semiotic, et cetera. ‘Naturecultures’ offers us an important route to rewrite these modernist oppositions [oppositional binaries] in such a way that rather than representing parts of the world, a transcription with the world is being proposed. Concepts thus do not capture or mirror what is ‘out there’, but are fully immersed in a constantly changing reality”
What Parikka describes is a world of exchange, relationality, and interactions that aren’t only dependent on humans or language, but are constantly changing and expanding as people, non-human animals, objects, and ideas interact with one another. Language, culture, clothing, rituals, perceptions all evolved and continue to evolve through ongoing interactions that are impossible to dichotomize in the way that language alone often does.
Turning back to MedicineNet’s acknowledgement then, that “biologic, psychological, environmental, and social factors all seem to play a part in PMDD” makes the diagnostic category of PMDD more nebulous when we ask, “What causes Premenstrual Dysphoric Disorder?” If bodies are understood in the context of social and historical conditions that have and continue to shape how we understand our world and the idea of a ‘self,’ then does this not give us another way to understand our body, menstruation, and a diagnostic category that itself has a derivative history that may be both helpful and harmful?
YEAH? SO WHAT?
Researchers and scientists have been debating what causes PMDD for years and it is a debate that I feel necessitates a Feminist intervention. Why, you ask? Well, for one, the debate rages on about whether PMS or PMDD is “real?” I, for one, believe this to be a ridiculous premise to get caught up in. I know my own body and experience my headaches, bloating, cramping, rage, cognitive disorientation, depression and sadness for myself. It’s happening and I don’t quite care if anyone thinks it’s real or not. What is most concerning, however, is that when I’m in pain or having difficulty functioning it means that a change of environment and requirement is necessary. What I mean by this is that what is required of me needs to be altered to make space for rest and self-care and this type of care can only occur in certain environments, usually someplace low stress, quiet, low-lit, and slow-paced. This becomes problematic for employees, students, mothers, and anyone economically deprived, requiring constant work and stress. Sadly, capitalism is built for consistency, efficiency, and productivity for profit, all of which are interrupted by, but not necessarily ill-effected by, variable processes (I will address this at length in future posts). In order to have my personal needs met, then, means that others must also understand the ‘realness’ of my experience to support or accommodate me and this is why many fight to have PMDD recognized as real and diagnosable.
On the other hand, the debate concerning the reality of a diagnostic category such as PMDD can become an unnecessary distraction from attending to WHY people might feel the need for this particular diagnostic category and HOW the diagnostic category is constructed. We must ask ourselves, who holds a stake in the existence of the diagnostic category of PMDD? Who benefits from its existence and what further harm might its existence do? These questions are not a matter of placing blame, dismissing experience, or finding fault in science, research, patients, women, people, or culture, but rather a means to understand the complex ways power disseminates itself across and into institutions, ideas, beliefs, and practices. Premenstrual Dysphoric Disorder has a history and has shifted nomenclature throughout. Women are actively participating in PMDD’s construction and upholding it in ways both valuable and dangerous. The amorphous quality of PMDD as a diagnostic category and its etiology (cause) opens up space for its largest stakeholders -women, non-binary, and trans folks who menstruate- to contribute to the ongoing debate and draw attention to the places where the medical and pharmacological community stand to profit first and help people second. The knowledge collectively produced via menstruators, medicine, science, and pharmacology can then be used to enact political legislation having both negative and positive consequences for people’s lives. This is no small thing.
For the most part, the diagnosis of Premenstrual Dysphoric Disorder appears to be the responsibility of physicians, doctors, researchers, and scientists all working together to establish parameters within which the disorder can be identified and treated. However, it is the responsibility of the individual seeking help, treatment, or support, to develop bodily awareness by recording their symptoms consistently over a matter of months. This fact is important because awareness and charting indicate that:
- people do indeed have a sense of their behaviors and feelings given that they can chart them
- people are capable of developing their sense of agency and expertise regarding their own body
- people participate in determining what becomes socially and politically salient (and sometimes to what ends -harmful or helpful- isn’t obvious)
A goal of many feminist movements is to establish and negotiate equitable practices within social, political, economic, and global circumstances. A brief survey of history, which I will undertake in my next blog, reveals a history of oppression against women within the socio-cultural framework. As someone who identifies as both a Feminist scholar and a woman diagnosed with Premenstrual Dysphoric Disorder, I feel responsible to others socially, politically, and globally. It is because of the work of feminist scholars before me that I am able to piece together parts of my history, America’s history, and women’s history that might otherwise have escaped my attention within America’s male-centered and driven patriarchal practices of neoliberal-capitalism.
Regarding my inquiries on PMDD, I am inspired by Chikako Takeshita’s “The IUD in Me: On Embodying Feminist Technoscience Studies.” Takeshita utilizes personal embodied experience with two IUDs, reading them against the racist and sexist political history of the IUD technology itself and those who manufacturer and distribute IUDs globally. What Takeshita found was that the global picture was troubling for women of color in places such as Indonesia, China, Vietnam, and Mexico. Additionally, it is Takeshita’s overall positive experience with the IUD technology during her academic research that reveals how the production of such technology targets particular users in different ways that help some, such as herself, but are disastrous for others depending on socio-cultural, racial, and economic factors. Takeshita’s subject matter differs from my own, but it is not a leap to consider the possibility that as globalization and Western ideas spread, so too might the repercussions of PMDD as a diagnostic category contribute to further oppression for those that menstruate. Ultimately, it may most affect those who are already economically and socially oppressed, such as women of color and indigenous peoples.
Akin to Takeshita’s methodological approach, my academic work is informed by personal experience as a medical patient and woman diagnosed with PMDD after years of menstrual difficulties. Similar to Takeshita, I will critically read my experiences with PMDD against the socio-historical, cultural, and political contexts that precede and include the diagnostic category of PMDD. Unlike Takeshita’s positive experience with the technology of the IUD which runs counter to its controversial history of disempowering many other women, my insertion into the diagnostic category of PMDD –and thereby the insertion and absorption of PMDD into my identity– was not altogether empowering. All the same, the diagnostic category did offer a name for how I felt and how I narrated my experiences at the time of diagnosis. Employing what Takeshita refers to as “reflexive embodied scholarship,” described as research based in direct experience and retrospective analysis, facilitates comprehension of the complicated history of Premenstrual Dysphoric Disorder and the benefits and harm it does as a diagnostic category.
Returning again to the original question, “what is PMDD,” I assert that PMDD is a nebulous diagnostic category formed from cognitive, psychological, and physiological symptoms and complaints during the late luteal phase and beginning of the menstrual cycle; “[b]iologic, psychological, environmental, and social factors all seem to play a part.” It is from this definition that I begin Undoing PMDD.
Takeshita, C. (2010). The IUD in Me: On Embodying Feminist Technoscience Studies.
Science as Culture, 19(1), 37-60.
New Materialism: Naturecultures in Utrecht