Intent and Purpose

My engagement in feminist analyses of Premenstrual Dysphoric Disorder (PMDD) is informed by my personal, biological, social, and political concerns. Around five years ago I was diagnosed with PMDD. For the better part of my menstruating life, I resisted my body because I felt that my mind and body were at constant odds. Suffering from PMDD made me feel like a stranger to and a prisoner of my own body. Like many diagnosed with PMDD, preceding my period I felt the sudden flick of a switch, my world going from light to viscous, debilitating darkness in a matter of moments without warning. As a teen, my premenstrual periods seemed the catalyst for emotional outbursts, interpersonal conflict, and dissatisfaction with the circumstances of my life. It wasn’t until I became a mother and wife, removed from the strenuous environs of my family of origin -which for many including myself are the formative grounds and reason enough to be combative and hurt- that I realized how destructive my menstrual pain and moods were for myself and those that I care for. For years I suffered cognitive, physical, and emotional disruptions and I still continue to have these symptoms most periods.

Throughout my years of developing relationships with people, studying midwifery, and being a mother and wife, I’ve taken note of the similar and dynamic experiences those that menstruate share. It is in this vein that I begin this blog. I have invested a great deal of time reading and carefully examining myself and others diagnosed with PMDD via forums and social media. Having done so, I see the impact of historically gendered diagnostic categories, social and cultural gender roles, biological sciences, economic forces, and biomedicine. Each of these inform and amplify the past and present political landscape making these subjects sites for careful and, at times, contradictory scrutiny. This blog is my attempt to speculate, trouble, question, and explain the nebulous diagnostic category of PMDD by way of questions, research, and auto-ethnographic (self-reflective) explorations. I will do my very best to be clear in my language acknowledging that each of us come from different places bearing very different knowledges. That said, I will be making use of academic vocabulary and the work that many scholars before me have done. As one of my favorite feminist philosophers and theorists, Rosi Braidotti, says:

“Please don’t get irritated by the occasional specialized language. It is the fate of philosophers to ask ordinary language to do extra-ordinary things and to work overtime…Don’t just dismiss it as jargon. Just approach it as a if it were a formula or a specialized code”

Language when put together in various ways does similar work that the different ingredients in your favorite family recipe might. Each inclusion on its own is one thing, but when flour, eggs, baking soda, baking powder, and sugar are mixed together it forms its own unique and seemingly singular entity. So, when I mention discourse or discursive practices here, I’m referring to the many parts that make a whole. It is for this reason that I’ve titled my blog UNDOING PMDD. I ask that you envision PMDD as a single, diagnostic category and from there, together, we will be exploring the many things that hold the category intact.  Much of what I write may induce vivid personal memories and in some cases an adverse response if it counters what you may hold as true in your own experience. I ask that we be willing to sit with this discomfort and work through it together. It is my hope that this space becomes a place to share, inquire, and commiserate with experiences we do not necessarily have ourselves. Many are just beginning to understand their bodies after years of disparate physical, emotional and cognitive events. Others have made peace with their diagnosis and have found ways of coping through exercise, creative endeavors, diet changes, therapy, anti-depressants, hysterectomy, bilateral salpingo-oophorectomy (the removal of both fallopian tubes and ovaries), and more. All of this is to say, there is no judgment in the way people choose to cope, manage, or cure their Premenstrual Dysphoric Disorder. I am not here to pass judgment or second guess anyone’s choices, but I am here to share from my own very situated knowledge gained amidst experience, observation, and research. I look forward to the exchange of information and UNDOING PMDD together.

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What IS PMDD?

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.”

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The following are the most common symptoms of PMDD taken from the John Hopkin’s website:

Psychological symptoms

  • Irritability
  • Nervousness
  • Lack of control
  • Agitation
  • Anger
  • Insomnia
  • Difficulty in concentrating
  • Depression
  • Severe fatigue
  • Anxiety
  • Confusion
  • Forgetfulness
  • Poor self-image
  • Paranoia
  • Emotional sensitivity
  • Crying spells
  • Moodiness
  • Trouble sleeping

Fluid retention

  • Swelling of the ankles, hands, and feet
  • Periodic weight gain
  • Diminished urine output
  • Breast fullness and pain

Respiratory problems

  • Allergies
  • Infections

Eye complaints

  • Vision changes
  • Eye infection

 

Gastrointestinal symptoms

  • Abdominal cramps
  • Bloating
  • Constipation
  • Nausea
  • Vomiting
  • Pelvic heaviness or pressure
  • Backache

Skin problems

  • Acne
  • Skin inflammation with itching
  • Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms

  • Headache
  • Dizziness
  • Fainting
  • Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs
  • Easy bruising
  • Heart palpitations
  • Muscle spasms

Other

  • 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.

Works Cited:

Takeshita, C. (2010). The IUD in Me: On Embodying Feminist Technoscience Studies.
Science as Culture, 19(1), 37-60.

New Materialism: Naturecultures in Utrecht

PMDD’s DSM-V Inclusion

In my search for information about PMDD, I stumbled across an article on Psychology Today from February 2012 titled The Inclusion of PMDD in DSM-5. The article’s tagline is “No, adding this diagnosis doesn’t mean women “go crazy” each month.”  Initially, Dr. Saedi appears to be offering a middle of the road account of PMDD, noting the differences in male and female biology while praising the uniqueness of both’s strengths. She even goes so far as to acknowledge the claims of some feminist theorists who oppose the inclusion of PMDD in the DSM-5 saying it would “essentially allow society to stigmatize women by pathologizing a normal part of their physiological makeup; further, this would only contribute to stereotypes about women as being emotionally unstable once a month (Daw, 2002).” To some degree, Saedi pokes fun at feminist theorists for dreaming up such seemingly hyperbolic ideas even as she proceeds to bolster their argument.

Saedi points out that “women’s rights activists are not keen on allowing such factors [menstrual related conditions] to be viewed as impairing or limiting women in any way,” but then asks what she perceives to be a controversial question, “does it matter?” Interestingly, the question is the caboose to a derailed train of logic. Given Dr. Saedi’s prior claim that up to an estimated 90% of women experience some type of symptoms premenstrually,  I believe she has unwittingly answered her own question. Yes, it matters that women’s bodies are pathologized given that menstrual experiences are similar for many of them! She goes on to assert that “[d]isparities in women’s health research has been problematic for decades. Despite evidence that issues such as menstruation are worthy of sustained research efforts…”  Saedi doesn’t directly address what might be the cause of such disparities in women’s health research, but it’s implied in what she writes next.

Utilizing Gloria Steinam’s essay, If Men Could Menstruate, Saedi implicitly indicates that if  men menstruated, there’d be government funded research to prevent the very real and normalized symptoms of the male body. Her conclusion welcomes pathologization by having PMDD recognized as a mental problem if it will get women the help they need. Not to be too hard on Dr. Saedi’s light-hearted disregard of hundreds of years of women’s oppression, but I’m uncertain how PMDD’s inclusion in the DSM-5 has the “potential to change factors about the way in which women’s mental health is conceptualized for the better”?

The article indicates that there are ongoing gender disparities, but Saedi takes no time to discuss the history of such disparity or the purpose it might serve to maintain systemic gender bias in medicine, science, and politics, biases that uphold men as logical, rational experts, even of women’s bodies and experiences. What’s valuable in Dr. Saedi’s article is the recognition that further research to help and support women is needed no matter the social biases. Dr. Saedi claims that a diagnosis, one that marks a pathological condition, might result in “more funding for research, and [a] better understanding of women’s reproductive health.” I agree that research and insight into women’s overall health is important and certainly has the potential to help women who are stuck in their suffering, pain, or lack of affirmation and understanding. But what are the benefits of having any of it understood from a pathological perspective? How might pharmaceutical treatments, hysterectomies, bilateral salpingo-oophorectomies, and diagnoses that reinforce the notion of women’s bodies and minds being disturbed because of their biology have adverse outcomes?

If women’s reproduction is inherently linked to mental pathology then it stands to reason that the only healthy woman is either one who is pregnant, premenstrual or menopausal because only in these states do those considered female not express marked behaviors or signs associated with difference from the normative white, heterosexual able-bodied, male’s behavior or physiological processes by and through whom scientific standards of normalcy and mental and physical health were historically determined. In any case, people who identify as women are always-already marked as different within androcentric (male-centered) institutional systems. Therefore, I’m uncertain how PMDD’s inclusion in the DSM-5 might change the sociocultural perception of women or the stereotypes surrounding their mental health. Saedi ends her article by asking “why should women suffer because of fears around stigma?”

I’d like to dig into this question to suggest that women suffer in part because of preexisting stigma that precede any fears around stigma pertaining to menstrual suffering. These preexisting stigmas accompany all deviations from the socially accepted idea of a “normal” or “healthy” body. Cultural understandings of mental and physical wellness are anchored to the white, male, heterosexual, able-body. On these grounds, I argue that women’s oppression is rooted in their preexisting stigmatization whether they’re menstruating or not, a stigma that’s been present throughout intercontinental history and then imported during colonialism to America. I will cover some of the imported, integrated, and persistent concepts that have become foundational to America’s philosophical, scientific, social and thereby politicized, understandings of women in my next blog.

 

 

 

 

Body as Boundary

Little of the research on Premenstrual Dysphoric Disorder addresses the discursive cultural environment of PMDD sufferers (and all people for that matter). There seems to be a lack in the discourse of PMDD regarding the distinct effects of the multitude of conversations in our surroundings throughout an individual’s development -conversations that take place in homes, churches, schools, and friend groups, etc.- on our personal conceptualization of our embodied experience. When we are taught that our bodies are somehow separate from our minds, referred to as the mind/body problem, then we tend to turn the medical gaze in on ourselves. Dissecting and evaluating our experiences -pain, emotions, and yes, even our mental states- can lead to the perception that there is something “wrong” with us depending on what the acceptable and expected cultural narrative of wherever one grows up or lives at any given moment might be. Because the body is often conceived of as an object rather than a material-discursive process of meaning building (mind) and retention of homeostasis (biology/physiology), health is framed and understood by many, as a stable and sustainable object and ideal. Material-discursive, put simply, is the idea that materiality, in this case, the flesh, blood, and bones that are our bodies and the discursive, the conversations, exchanges and relationships within which these occur, frame the knowledge produced, the conversations we have as we compare and contrasts interactions and exchanges, and how we even come to know ourselves as human, subjects of the world, and/or different from other forms of materiality (such as things, places, nonhuman animals, etc). To quote Susan V. Scott paraphrasing Taylor, “…bodies, spaces, and objects are, at any given time, what practices have made them.” Language and practices are constitutive of bodies and vice versa. Relationships to the earth, to one another, and to the objects we have created and named to then discuss through these relationships, all emerge from deciding what boundaries exist. One boundary-making example I like to use is that of a tree:

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 We discuss trees as a single thing, an object that exists independent of us (humans) and the ground and sky. Yet a tree requires photons from the sun, wind from the sky to create movement that strengthens its branches and trunk, and sustenance and water from the ground, to flourish. The tree then puts out oxygen that all living creatures are dependent upon to survive. Additionally, when the tree dies and decomposes, it breaks down to feed and supply the soil with nutrients that continue that feed new trees. Nothing exists independent of its surroundings, yet we discuss life, human, animals, plants, cars, and other objects/things as if they do. This is of great importance to our personal understandings of health and our bodies.