Rage, depression, despair: Why is PMDD still so poorly understood?
Gender difference is intimately stitched into the fabric of humanity, and at every stage in its long history, medicine has absorbed and enforced socially constructed divisions and assumptions.
These divisions have traditionally ascribed power and dominance to men. As modern scientific medicine evolved into a discipline, institution and profession, it flourished within these dynamics.
Women were marked by their anatomical difference from men, and medically defined as defective, deficient and deviant. But women also possessed an organ of the highest biological – and social – value: the uterus. Possession of this organ defined the purpose of women: to bear and raise children. Being biologically female defined and constrained what it meant to be a woman. And being a woman was conflated with, and reduced to, “the female sex”.
Medicine validated these social determinants by constructing the myth that woman was her biology, both physically and psychologically, and for centuries, women’s illnesses and diseases were consistently related back to the “secrets” and “curiosities” of their reproductive organs, menstruation, pregnancy and childbirth.
As much as women’s bodies and their processes have been medicalised and pathologised, so too have female hormonal states tied to menstruation including perimenopause, menopause, premenstrual tension (PMT) and, more recently, the hormonal mental disorder known as premenstrual dysphoric disorder (PMDD).
In her first work of non-fiction, Hell Days, Australian novelist Laura Elizabeth Woollett interrogates PMDD, or what she describes as “the inferno of hormonal mood disorder.” Interweaving memoir with investigative journalism and medical research, she explores the condition in several ways: the articulation of her own experience, research into the correlation between the menstrual cycle and mood disturbances, and interviews with fellow sufferers, as well as doctors and research scientists.
With the benefit of diagnosis, treatment and hindsight, Woollett writes with clear-eyed honesty about her own jarring, cyclical experiences with PMDD. She remembers, for example, sitting under the harsh fluorescent lighting of the call centre where she worked, actively deciding to avoid taking the train to and from her job because of the depression and suicidal ideation with which she was struggling. She did not, she reveals, trust herself not to jump in front of a train.
Likewise, she chronicles many years of emotional (and likely also hormonal) destabilisation, including struggles with mood fluctuations, body image and eating disordered behaviours, that she only correlated with her menstrual cycle while on holiday with her husband in Thailand in 2018. Feelings of heavy depression and vivid death fantasies plagued her until her period came and suddenly, she writes, “I felt fine again.”
She googled “PMS rage depression” and found information about PMDD. It was only then that she became aware of the condition which can cause severe emotional and physical changes before a woman’s period. Symptoms of the disorder can include, but are not limited to, depression, anger, irritability, difficulty concentrating, insomnia, lethargy, feelings of being out of control and suicidality. Most disturbingly, the illness is estimated to affect as many as one in 20 women, one in three of whom will attempt suicide.
As Woollett’s extensive research and interdisciplinary approach to her topic makes clear, relatively little that is concrete or scientifically verified is known about PMDD. Indeed, it was only in 2013 that the condition was formally moved out of the appendix of the psychiatric bible, the Diagnostic and Statistical Manual (DSM), and recognised as a stand-alone depressive diagnostic category.
Treatment for the illness remains frustratingly experimental with doctors recommending sufferers take some form of oral contraception, antidepressant medication, hormone replacement therapy or even consider a hysterectomy, and research is predictably underfunded.
More needs to be done, clearly, and that urgency underlies the wide-ranging discussions Woollett has with general practitioners, obstetricians and gynaecologists, psychologists and psychiatrists, scientists and researchers, as well as fellow sufferers.
Woollett’s accomplished and deeply impressive book is the second to be published in Australia this year on PMDD and sits comfortably alongside Emma Hardy’s insightful and personal Periodic Bitch as an important exploration of a medical condition that is both affecting vast numbers of women and radically diminishing the quality of their physical and mental health.
Ultimately, what both volumes demonstrate is not only the depth and breadth of women and their suffering but that, at the intersection of menstrual and mental health, healthcare providers and broader healthcare systems worldwide are continuing to fail women in their responses to and treatment of their pain.
Hell Days: Into the Inferno of Hormonal Mood Disorder by Laura Elizabeth Woollett is published by Scribe ($33).
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