eleven months pass...
I post this without agenda or comment, other than it always stuck in my head since the one time I tried to discuss it, my flatmates just said it was obviously men doing the research.
IN THE BLOOD OR IN THE HEAD?
By Catherine Bennett.
1 June 1993
The Guardian
In the beginning was the Curse of Eve. Then came PMT, PMS and a multi-million-pound industry
Menstruation always did have a scurvy reputation, what with blighting crops and souring milk, but it took 20th century science to discover that women could be possessed by evil spirits before their periods had even begun. In 1931, premenstrual days were found to be a time of tension and hostility. They deserved a name of their own: PMT.
Then in 1953 Dr Katharina Dalton, a former chiropodist, spotted a multitude of new symptoms, and invented something better: Premenstrual Syndrome, or PMS. This majestical syndrome embraces clumsiness, amnesia, fatigue, depression, anxiety, mood-swings - 150 different symptoms! It can account for completely contradictory states of mind: lethargic and energetic; lecherous and unresponsive. It can explain failed exams, sottishness, bingeing. In some countries the syndrome remains almost unknown. In Britain, where estimates of prevalence have climbed as high as 95 per cent, PMS has been accepted as an excuse for shoplifting, arson and homicide.
As yet, the excuse is available only to the fertile and female, but the syndrome still offers generous perks for males too. Confronted by a querulous woman, for example, a man may attribute her plaints not to reason but to an eruption of hormones. More profitably, he can establish a private practice specialising in the treatment of PMS. As there is neither an aetiology, an objective method of diagnosis, nor a plausible cure for PMS, but a placebo response as high as 94 per cent, one patent remedy is as likely to attract custom as another.
For druggists and farmers, there are fortunes to be made from over-the-counter "food supplements" purporting to ease the symptoms of PMS. Vitamin B6 enjoyed a profitable vogue but has now been supplanted by Oil of Evening Primrose, creating a UK market worth #32 million. There is no convincing evidence that the oil alleviates any PMS symptom other than breast pain, but last year sales rose by 80 per cent, and Sarah Collins, an Evening Primrose PR, maintains that "actually it does seem to work in helping to combat some of the symptoms of PMS, notably tension". But didn't a recent study show that a paraffin oil placebo could be equally effective? What serious claims does she make for it? "We don't make any claims at all," Collins says, adding that 250mg a day, every day, is her recommended dose. If women will buy that, why should they not put their faith in Milk of Morning Turnip, or Elixir of Moonshine? "If someone had said eat seaweed," says Jackie Howe, a PMS sufferer for 17 years and treasurer of The National Association for Premenstrual Syndrome (Naps), "if someone had said eat coal, I would have done it, because it was any chance of feeling better."
Howe offers a convincing account of her pre-menstrual torment and its alleviation by Dr Dalton. "Unless you are a sufferer yourself you wouldn't know just how devastating it is. I was a complete zombie, I couldn't function, and there are lots of women around like that." And in April many of these part-time zombies were wholly enraged when a conference of the British Psychological Society presented papers suggesting that PMS was more of a social construct than a useful medical definition. Dr Jane Ussher, for example, suggested that PMS could be "a way of legitimising and expressing distress".
"Thus," Anna Reynolds blustered in the Observer, "the millions of women who spend up to 10 days each month in agony ... are being told that they would rather blame their hormones than accept that life is stressful. Those same women, many of whom have lost partners, killed their young children, killed themselves, injured someone else, lost jobs and friends through this condition, have spent a fortune on so-called cures and fashionable treatments, only to be told that they are imagining it all." Her indignation was easy to understand. If Reynolds had not been diagnosed by Dr Dalton as suffering from severe PMS, she might not have been acquitted of murdering her mother in 1986. Now, happily, she is at large, controlling her symptoms with a diet of starch.
Curiously, the Sun newspaper was equally consternated by the theory that women might not be the dupes of their hormones, devoting a leader headlined "Pompous Male Twit" to an attack on a dissenting psychologist. Woman's Own magazine defied the shrinks with a readers' PMS questionnaire which revealed that "nine out of 10 of you suffer from it". All their questionnaire had actually proved was how eager self-diagnosed sufferers are to declare themselves. So it was perfectly reasonable for rival New Woman magazine to present women with the opposite discovery: "PMS, The Big News: It Doesn't Exist." Company magazine offered readers a free sanitary towel and this nifty compromise: "Surprise! The good news about PMS - 25 per cent of women f eel better before their period."
How far have we got with the study of PMS? "It's in its infancy, I think we need to go back to the beginning," says Shaughn O'Brien, professor of obsetrics and gynaecology at the University of Keele. "I think we're probably going backwards," says Dr Anne Walker, a lecturer in psychology at Dundee university. "The whole thing is a mess."
First, she says, we have no idea of the extent of the phenomenon. "We haven't actually spent much time looking at the people for whom it's not dreadful, who are the key to everything, really." Then there is the question of gender and PMS. "There are differences in what's considered normal behaviour for men, and normal behaviour for women. We haven't considered how gender - mostly male clinicians, studying all female patients - how that has affected the results, or the things which have been discovered."
But still, as the Woman's Own survey demonstrated, many women are loath to surrender their slackly defined, supposedly enfeebling syndrome. And it is female doctors, such as Caroline Shreeve, the "well-known health author", who advise women not to drive, ride a bicyle, or attend an important meeting when the "demon inside you" is up to his mischief. This skilled medic further recommends that "victims" reserve dark glasses, worry beads and special outfits for PMS days. "Try to avoid black - it's far too funereal."
Similar infantilism has long been promoted by Dr Katharina Dalton, the celebrated begetter of PMS. Dalton, who is disturbingly attached to expressions such as "the curse of Eve" and "Jekyll and Hyde", instructs the "menfolk", in one of her many works on the syndrome, to keep a benevolent watch on their wives. "If she has a taste for alcohol, she may well have uncontrollable alcohol urges during this time, so keep an eye on the home supplies and if they are going down too rapidly remove all alcohol from the hous e. Explain to the children that Mother is not well today."
If Mother is very, very unwell she may wish to join PMS Help, another support group run by Dr Dalton's secretary and daughter, Wendy Holton. PMS Help recommends and sells a variety of pamphlets and books composed by the Dalton family - Wendy Holton, her late father Tom Dalton, Dr Dalton herself, with indexing by Dr Dalton's grandaughters. "To say it doesn't exist or it's all in the mind is rubbish!" says Holton, who has no medical qualifications, but who lectures energetically on PMS nonetheless, answering questions such as: "How long does PMS go on for?" "How long is a piece of string?" she chuckles.
Doesn't she worry about advancing the idea that women are in the grip of their hormones? "Of course we are," Holton says indignantly. Then what does that say about women's suitability for jobs where composure and steadiness are desirable? "A woman with severe PMS will never get to having a pilot's licence," Holton claims, ignoring studies showing that pre-menstrual women do not display any specific cognitive impairment. "They will never get to be consultants at hospitals because they fail their exams, they give it up."
At the dynastic headquarters in Harley Street Dr Dalton prescribes progesterone suppositories for severe cases. "If we don't have enough progesterone premenstrually we end up with PMS," she explains, putting down a digestive biscuit and drawing a little picture of a cell with squiggles in it. "The disease of PMS is a disease of progesterone receptors." But if there's no evidence of hormonal abnormality in PMS sufferers, how can there be any to support her theory of faulty receptors? "Well there isn't," Dalton says, placidly. "We can't measure them because we'd need to have a biopsy of the brain."
So what's her success rate? "Forty years of treatment!" she cries, hastening to expound her other theory, that lack of food can also afflict these capricious receptors. "We can make sure that people don't go long intervals without food, and we can correct PMS in 60 per cent of cases." She sings the praise of starch, assiduously ingested.
It is discourteous, but surely not irrelevant here, to mention the king-size, if not unhealthily overweight figures of both Dr Dalton and Wendy Holton. Some PMS sufferers may wonder which is worse: occasional wonkiness, or permanent obesity. Nor is Dalton's thesis enhanced by her habit of arguing from the particular to the general. Rather than conduct double-blind tests, which she considers unfair to recipients of a placebo, she prefers to dwell on dramatic individual successes. If she's right, why don't all the other PMS specialists, such as Mr John Studd, MD FRCOG, consultant gynaecologist at Chelsea and Westminster Hospital, share her methods? "Okay, it's a male, and they don't like the idea of using suppositories or pessaries two or three times a day," Dalton says, weirdly. "They somehow feel the woman's vagina is for them to put things in," her daughter clarifies.
In fact Studd has different objections to progesterone . "It's not only untried, it's been studied in all sorts of studies now and shown not to work," he says. "The great scandal is how Katharina Dalton gets away with it. It is in my view about the biggest medical scandal of the 20th century. I know you won't quote me, but I'd love you to." Then how does Dr Dalton prosper away in Harley Street? "It's because nice female journalists look at the facts, they've got friends who've got better with progesterone, they might have got better on progesterone, so they write a spiel on progesterone and say, in spite of all the hostility about it, it still works because I've tried it and I feel better."
Nice Mr Studd is no more complimentary about the psychologists who share his view of Dr Dalton's methodological quirks. "Psychologists have mostly got their minds stuck in Freud in 1880 in Vienna and they haven't progressed from there," he says, seeming to have mistaken them for psychoanalysts. "They don't believe in any hormonal basis of PMT, their works define some environmental cause, and they're backed up by the feminists - because they're mostly women - that life is tough being a woman ..."
He estimates that "10 or 20 per cent" of women suffer from PMS enough to undermine their "home happiness and their efficiency at work". Would he care to define PMS? "I'm not sure your readers want a definition," says Mr Studd. But readers love definitions of PMS! We want to know if our efficiency is being undermined. "It is distressing psychological or physical symptoms which occur regularly with each ovarian cycle, and which significantly regress throughout the rest of the cycle." What kind of distressing symptoms? "Depression, loss of energy, loss of libido, irritability, agoraphobia, aggressive violent behaviour and so on." Leaving aside the question of who, exactly, might be more deprived by a temporary loss of libido, how does he cure it?
"PMS isn't caused by periods, it's caused by cyclical changes in the ovaries, and if you wipe out those you have no PMS." Simple, isn't it? If thine eye offend thee, pluck it out. Mr Studd gives severely affected patients oestrogen patches or implants to wipe out ovulation, or suppresses the pituitary function to induce medical menopause. "Women with severe PMS invariably prefer hot flushes and sweats to their PMS," he claims brightly in a recent paper. "But this is not suitable for long-term therapy as women can lose about 8 per cent of their skeleton after a year's therapy!" Tssk!
Dr Dalton grumbles that Studd doesn't follow up his patients, alleges that his "failures" end up in her surgery, and believes that he doesn't recommend her biscuity diet because it's too cheap: "If you do an implant you can charge a nice lot."
But so, with her books and consultations, does Dr Dalton. So, at #4.75 for 50 capsules, do the producers of Evening Primrose Oil; so does Dr Alan Stewart of the Women's Nutritional Advisory Service. Stewart thinks PMS may be linked to a mild magnesium defiency, not hormones, and alleviated by an improved diet, exercise and nutritional supplements. "Even if I'm overstating the case for nutrition, at least it will result in the woman being in control of her own symptoms," he says. "Don't trust anyone in this field other than your own judgment."
"The sufferer is in the middle of it all," complains Jackie Howe of Naps, who now has reservations about Dr Dalton's dietary tips. "I would have mortaged my house, I would have sold any jewellery I had to see her, because it's a desperate situation." But for how many? "Usually the estimate is probably up to 30 per cent get the symptoms badly enough to have some sort of treatment."
"It's been blown up out of all proportion," says Dr Anne Walker. "If you walk down the street and you look at all these women, you think, well, statistically 25 per cent of them are premenstrual, and the world carries on."
Even so, many women who do not regard themselves as disabled by PMS would still recognise symptoms from the PMS inventory, such as dolefulness or irritability. "Exactly," says Dr Walker; "the question is, is that a disease?" Well - their partners often say it's a problem. "The radical feminist argument would be, who's being inconvenienced here? Maybe we should be worrying about who wants to call it an illness and who's being inconvenienced."
As an expert witness on PMS, Dr Dalton has helped reduce murder charges to manslaughter, an achievement which, if it has any validity, must surely inspire male doctors and murderers to come up with an equivalent? "I don't think men or women should be excused committing violent acts on the basis of hormones," says Professor O'Brien. "In fact men may come off slightly worse there. Because no one will say that was his hormones and he should have these sort of mitigating circumstances: 'Oh yes, sorry I did the rape, my testosterone levels were a bit high today.' Maybe that's true - that doesn't excuse it."
As a method of pathologising, weakening and stigmatising women, PMS is possibly the greatest advance since 19th century quacks dreamed up female "hysteria" - another vague syndrome, another grand hodge-podge of ill-assorted symptoms which could only be cured by tinkering with the reproductive organs. But this time women themselves are advertising their complaint, exaggerating its occurrence, often wrongly diagnosing their own cases, demanding medical intervention. Even Dr Dalton, not one to under estimate the prevalence of PMS, has found that half the patients referred to her do not have the disorder.
For feminist psychologists, it's a poser. "We have to acknowledge that for some women this label PMS is very helpful in terms of getting them attention," says Dr Walker. "So many people have a concern about being labelled as mad, or they would prefer to say I've got PMS and get anti-depressants from a gynaecologist than say I'm depressed, and have to go and see a psychiatrist."
Like depression, PMS cannot be objectively measured. Who is to say that a woman's periodic volatility is more bothersome than a man's fortuitous mood changes? "Men's moods differ just as much as women's, but they don't have anything to relate it to," says Dr Precilla Choi, a lecturer in health psychology, and among those vilified after the April conference. "For some reason, because women have a biological clock to pin it on, it's considered a negative thing to have mood changes. But it doesn't necessarily have to be."
So what should a woman do if she thinks she has PMS? "My own feeling is they should be going to a psychologist, because its behaviour," says Walker. And Mr Studd? "Oh, keep them away from psychologists, they're useless - they're useless; I mean forget it!" The decision is yours. But best to make it, during the Jekyll half of your cycle, before the demon is inside you. Better still, why not ask your husband?
― N. (nickdastoor), Wednesday, 14 January 2004 22:57 (twenty-one years ago)