Sunday, November 23, 2008

PMS

I seem to have caused a bit of a shitstorm over on Ambivalent Academic's blog because of my comments on this post. Reading my comments back to myself, I realized that not only was I not really making any sense, I also was totally not conveying the point I was trying/hoping to make. So after re-reading the material I was referring to, I am taking this opportunity to address the issue. The issue in question? PMS. 

Now I would like to offer a few disclaimers before I get into this - first, the material I am referring to is dated. Myths of Gender by Anne Fausto-Sterling is copyrighted 1985. Second, I don't give enough of a shit to do a lit search and read a bunch of articles on PMS so that I have all the updated science. It's not my field. But human behavior is, and so is feminism. My goal is to give you something to think about, not to convey worldly truths. 

Anne Fausto-Sterling is a biologist at Brown University. Her book, and specifically the chapter on PMS is mostly about critiquing so-called science-based differences between men and women that society just accepts as truth. 

Pages 95-96 of her book include the following quote by three scientists in 1974:

"It is estimated that from 25% to 100% of women experience some form of premenstrual or menstrual emotional disturbance....Eichner makes the discerning point that the few women who do not admit to premenstrual tension are basically unaware of it but one only has to talk to their husbands or co-workers to confirm its existence."

Fausto-Sterling writes in response to this quote:

"Is it possible that up to 100 percent of all menstruating women regularly experience emotional disturbance? Compared to whom? Are males the unstated standard of emotional stability? If there is but a single definition of what is normal and men fit that definition, then women with 'female complaints' must by definition be either crazy or in need of medical attention. A double bind indeed." 

On page 100 she says the following:

"Many of those who reject the alarmist nature of the publicity surrounding PMS believe nevertheless that women undergo mood changes during their menstrual cycle. Indeed most Western women would agree. But do studies of large segments of our population support this generality? And if so, what causes these ups and downs? In trying to answer these questions we confront another piece of the medical model of human behavior, the belief that biology is primary, that hormonal changes cause behavioral ones, but not vice versa. Most researchers use such a linear, unicausal model without thinking about it. Their framework is so much a part of their belief system that they forget to question it...."

She goes through the types of research that have been used in studying PMS, including correlational designs and retrospective questionnaires. I think all of us know the problem with correlational studies used to infer causation, but on the questionnaires she says the following:

"The retrospective questionnaire holds additional problems, including the selective memory of the women completing it combined with their prior knowledge of the purpose of the study. Many women grow up with the expectation that they should feel bad just before their periods, and this belief can certainly predispose them to selectively remembering feeling bad just before menstruation but not at other times of the month. As one researcher writes in a study on moods and menstruation in college students, 'negative behavior exhibited premenstrually is perceived as evidence for the prevailing negative stereotype of female emotional behavior while positive behavior is ignored as something for which biology is irrelevant.'"

On page 109, and highly relevant to the discussion at hand, is the following:

"Dr. Sharon Golub found that premenstrually related increases in anxiety were far smaller than the heightened anxiety experienced by students subjected to the stress of an examination. In general she found premenstrually related mood changes to be of small magnitude, concluding that 'the premenstrual hormonal changes appear to impose little psychological burden,' and are often so slight that women 'are sometimes not even aware of them.'" (The citation for this study is: "Premenstrual Changes in Mood, Personality, and Cognitive Function" in The Menstrual Cycle, vol. 1.)

Now, the overall argument that Fausto-Sterling makes is that the PMS research prior to the date of her publication was extremely flawed. 

We're all scientists in one form or another here. We know the importance of random sampling, double-blind procedures, the inherent faultiness of self-reports, and control conditions. 

Problem #1: Participants are nearly always a restricted sample in PMS studies. Women of a certain age, on a 28-day cycle, all with prior complaints of PMS symptoms. 

Problem #2: The definition of the problem. What, exactly, constitutes a symptom of PMS? Headache? Moodiness? Dizziness? There is no symptom of PMS that cannot also occur at other times of the month. Nor is there a symptom of PMS that men cannot also experience. (I'm not talking about menstruation symptoms, just the PMS). They can say what is most common, but they can't actually define PMS by its symptoms. 

A seemingly pissed-off Arlenna posted an article in response to my comment on AA's blog, entitled "The female brain hypoestrogenic continuum from the premenstrual syndrome to menopause. A hypothesis and review of supporting data." Who wants to tell me what's wrong with that title? If you read through the synopsis of the article posted on AA's comment section, you'll see that this was not an experiment. This is an attempt to "unify" PMS symptoms including: "depression, sleep disturbance, irritability, anxiety and panic, memory and cognitive dysfunction and a decreased sense of well-being." Is there anyone in the world who doesn't experience those things throughout the month, not just around her period?

But here's the part that I find offensive: "It is proposed that whenever brain estrogen levels fall below the minimum brain estrogen requirement, for whatever reason and at whatever age, brain center dysfunction may ensue."

Brain DYSFUNCTION?? I say FUCK YOU to that. As Fausto-Sterling argues, if women are rendered "abnormal" during their menstrual cycle, what the fuck is normal? 

If our brains, as women, are not FUNCTIONING properly because of our hormone levels, then why the fuck aren't we all put on medication to correct this? This is what you ladies aren't getting that I'm trying to explain to you - NOTHING about your behavior during your menstrual cycle should be considered "abnormal" because it's "female-related." So you cried during the exam, AA, is it okay with you, after you walk out of the exam, for the committee to say "Oh, she must be PMSing?" Because it's not okay with me. Not at all. 

Testosterone cycles monthly just like estrogen. Why is no one examining the effects of that on men? Because they are the "normal" standard, whereas we have something WRONG with us because we are female and have female hormones. 

But back to the problems with the research. 

Problem #3: Agreement in the literature. Some studies look at only the first couple of days preceding the period, others look at the week preceding, and still others look at the 2 weeks prior AND the week following. It's a 4 week month, people. Are you telling me that women are only "normal" for 12 weeks per year? Because if so, that's fucked up. 

The other article included by Arlenna was first of all from the field of psychiatry. The medical study of ABNORMAL human behavior and MENTAL DISORDERS. Again, the article is NOT an experiment. It was a literature review resulting in a hypothesis about serotonin levels in women with severe PMS symptoms. One important quote from this article: "Their pathophysiology is still unknown, despite increased interest and research."

Now here's some hot fucking social science for ya. From "Transformations: Women, Gender, and Psychology" by Dr. Mary Crawford, in reference to the psychiatric article Arlenna mentioned and its focus on "Premenstrual Dysphoric Disorder" (PMDD):

"PMDD currently appears in the DSM-IV appendix of potential categories needing further study. It does not appear as an official category because of insufficient support; however, it can still be used by psychiatrists and other doctors as a diagnosis. Contraversy continues to rage regarding the inclusion of PMDD in the DSM. Supporters claim it is an identifiable clinical syndrome and its inclusion in the DSM is important to legitimize some women's cyclical suffering. Some critics agree that the validation of women's experiences is important, but assert that women should not require a mental illness diagnosis to receive medication for physical and emotional symptoms commonly associated with menstruation. Also, the existence of this diagnostic category may reinforce the stereotype of premenstrual women as emotionally unstable. " Page 456. 

So here's the deal, folks. No one has quality experimental research demonstrating that hormones CAUSE the symptoms known as PMS. Most researchers don't even know what PMS IS in a well-defined, testable way. 

Obviously this issue is incredibly important to me, because I just spent the last fucking 2 hours writing this post. Saying that your behavior is due to hormonal changes you experience because you are a WOMAN is short-sighted and the fact of the matter is that we cannot separate expectations from biology. Not yet, anyway. 

Refer to the debate that was going on at Dr. Isis' blog on the effects of different alcohols. My argument over there was that we have no idea what's really going on when I drink tequila versus vodka as far as the physiology goes, and so I and a few others used anecdotal data in support of our conclusion that tequila is an evil substance. If we consider these two issues to be fundamentally the same, I was arguing on the opposite side for the alcohol issue. 

But the fact of the matter is that whether or not tequila causes physiological things to happen in my brain that make me a raging lunatic speaks to whether or not I should drink tequila. 

My tequila issues will not prevent me from getting a certain job in the military unless I make it a problem. But PMS and hormones causing "brain dysfunction" because I am a WOMAN can and DOES prevent women from doing certain things in this world. 

I refuse to accept that my behavior is "abnormal" because it's "that time of the month." 

4 comments:

Ambivalent Academic said...

As I said in the comments at mine, I think that your point of view here nicely illustrates the reaction to the marginalization of women that is founded on a perception that our propensity for estrogens over androgens makes us a bunch of crazy bitches. I get it. And it totally pisses me off. Nonetheless, as much as I wish I didn't, I do experience these symptoms and as a biologist who studies hormones I cannot categorically ignore their effect because it suits my agenda.

Here's the thing. It's not "abnormal". I experience it every month. Lots of women do. If every woman did 50% of the population would have these symptoms every month. That, to me, makes it very "normal" with respect to the population at large.

However, when I compare my most intolerable mental-emotional state that I experience for a few days each month to how I feel for the majority of the rest of the month, it is "abnormal" FOR ME. (See the difference in my "baseline" comparison?) I do not feel like the me that I know, I am compromised in my ability to DEAL with the crap that comes with my job, and that bugs the shit out of me, but I hold it down as best I can. Yes, I feel that that is a brain dysfunction BUT I sure as shit don't want anyone else to call it that because I don't want the stigma of a mental illness laid on my name or my professional persona or my gender.

I KNOW that fluctuating hormones can affect my mental state and make me feel abnormal as compared to myself that I recognize when my hormones are stable, but I do NOT want for that to be an excuse for other people to marginalize my rationality especially since I am in a field that requires me to be rational to do my job well. Which is precisely the dilemma that Arlenna and I were discussing.

Yeah, I lost it in my exam. Do I want people to say "that's OK, she was PMSing"? FUCK no, and I find it somewhat offensive that you would imply that I would want to hide behind this marginalization of women. I think the fact that I will never feel comfortable setting my advisor straight on what really happened their speaks to this quite clearly - I don't want him to see me as "abnormal" or "unstable" or "irrational" because of something I can't change with out a hysterectomy (not that I would want to). That would be bigotry, but as you acknowledge it happens everywhere and has been going on for centuries so I KNOW the danger of bringing it up. Just look at the reaction it got from you...and you're not writing my letters of rec.

I rather found quite a bit of comfort in the realization that the medication I was on exacerbated my expected exam-related stress level to the point that I cracked. I wasn't losing it. I didn't have an anxiety disorder. I wasn't mentally ill. I had a side effect reaction to my medication.

The fact that the medication is a hormone changes absolutely nothing about it. I introduced a substance into my body and it had an unintended effect - it amplified my anxiety - no big surprise. The fact that I know a little bit about the biological action of said substance allows me to draw some corollaries to how I know said substance functions in my body at endogenous levels.

That is all.

JLK said...

AA, I was not at all trying to imply that you would EVER hide behind hormones or that it would be okay with you if people said that you were PMSing after you left the room. I am very upset that I have offended you, because that was never my intention.

Arlenna and I have turned the conversation in a direction that is more toward what I was trying to get at over on her blog. My point was more that you were in an anxiety-provoking situation that was likely amplified by the hormones. But there is always a situational factor to be dealt with that cannot just be ruled out.

Now your science, and the same with Arlenna's, deals with the physical nature. My specialty field, by its very definition, focuses on the situational influences that change our behavior and emotional states. So I'm coming at this from a slightly different perspective than the two of you, though we all agree that as women, our hormones do affect us in ways that we're not always happy about.

My heart broke for you when I read your story about crying during the examination. I haven't been in the same situation, but I've had experiences like it.

There are just so many different variables when it comes to human behavior and emotion, which is why science finds it so difficult to even define premenstrual symptoms. I know that you think I'm saying we should ignore hormonal effects because of the politics behind them, but that's not really what I'm saying.

What I'm trying to say is that unless and until some hard, good science proves that fluctuating hormones cause women to be miserable around their periods, I hesitate to attribute it all to the biological factors that inherently make us female.

The worst part about it is even if a really good study came out that pretty much proved that estrogen level doesn't cause women to act in erratic ways, no one would believe it.

Gender is something I study extensively. And one thing I know from my research is that the stuff that gets published is the stuff that demonstrates a difference between men and women. It's considered sexier, it sells more journals and lands in newspaper headlines.

But all of the research that shows men and women to be the same gets swept under the rug because it doesn't conform to our society's expectations.

Remember when the studies were published that said boys are naturally better at math than girls? How much press that got, and how many people still believe that?

There have been TONS of studies that show girls and boys to have the same abilities, but that they get altered by environmental factors like the timing of math education, stereotype threat, expectations, and sexism in the classroom. Why don't we ever hear about those studies?

It's the nature of my field. I have a really difficult time ever accepting biology as the only influence for anything.

Professor in Training said...

JLK: I may not agree with you, but you're entitled to your opinions so stick to your guns about your argument. The response you've generated from this is very reminiscent of the other hot topic about people being confronted about their work in a public forum (ala Grand Poobah's). Watching intelligent, articulate scientists argue back and forth is what makes science fun. Welcome to the blogosphere!

Ambivalent Academic said...

JLK - I think that both of our arguments have been so absorbed in illustrating our own points that neither of us have articulated well what you just said - that it is a COMBINATION of factors, both biological and environmental that impact our behavior.

Do hormones have a biological effect on behavior? YES!

Are they the only factor? Of course not! If I had not had to stand for that exam on that particular day would I have had an anxiety attack? I don't know but I really doubt it. If I had not been on this hormone medication while taking my exam would I have had an anxiety attack? Again, I don't know but given a personal history of nailed oral exams without issue, I sincerely doubt it.

So the point is, both have a real effect on our behavior, and we DO try to sweep the hormone issue under the rug for fear of feeding anyone's misogynistic fantasies.

Don't worry about offending me. I get riled up and take things too personally sometimes, but I don't hold grudges.

My goal with that post was to inspire some discussion on the matter, and I'll say it was a huge success...would have been FAR less interesting without your input. I'm going to go read Arlenna's now.

Related Posts Plugin for WordPress, Blogger...