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American Premenstrual Syndrome: A Mute Voice

Author(s): Alma GottliebReviewed work(s):Source: Anthropology Today, Vol. 4, No. 6 (Dec., 1988), pp. 10-13Published by: Royal Anthropological Institute of Great Britain and IrelandStable URL: http://www.jstor.org/stable/3032946 .

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years Canadianmuseums have made substantialpro-

gress in involving Native People in their activities, al-

beit often still in a ratherpatronizing way ('The Cel-

ebration allowed [sic] native peoples to present...').The

failure,not only of the Glenbow Museumbut of other

major museums across Canada, o take seriously the re-

quest by the representativesof most of the Native

People in Canadafor a boycott has been a grave set-

back to this rapprochement.Harrison might have dis-

cussed in more detail why the Glenbow's later efforts

tomeet

with local band councils failed; clearly, more is

involved than finding mutually agreeable meeting

times. Curatorsmust now decide whether they will re-

treat into their bunkers or play a responsible role by

trying to do what is in their power to redress the nega-

tive consequences of 500 years of Europeandomina-

tion. Academic freedom will have real meaning in the

settingof publicly-financedmuseums only when it does

not clash with the equally important reedom of Native

People to manage their own cultural heritage. The en-

thusiasm with which Native People are establishing

theirown museums across Canada,often with minimal

public financing, refutes any suggestion that they are

not interested n doing this. How the present Euro-Ca-

nadian museum community respondsto the challenge

to stop treating the Native heritage stored in their mu-

seums as theirpersonal possessions will reveal the kind

of people they really are.

American PremenstrualyndromeA mute voice

ALMAGOTTLIEB

Alma Gottlieb sassistantprofessor ofanthropologyat theUniversityof Illinois at

Urbana-Champaign. heis co-editor (withThomasBuckley) ofBlood Magic: the

Anthropologyof

Menstruation U. of

CaliforniaP., 1988).

In America there is much talk these days about

'premenstrualyndrome', or PMS, heraldedas the mostimportant women's health issue of the 80s (Witt

1984:27). The medical communityincreasingly claims

PMS as a biological fact: with organiccauses, it can be

diagnosed andcured,especially with hormones (proges-

terone) (e.g. Dalton 1979). But some feminists are rais-

ing a wary eyebrow at this development,which has an

eerie ring of the nineteenthcentury (for other critiques,

see Sommer 1982, 1985; Koeske 1985; Rome 1986).

Only last century a woman's entire being was seen as

ruled by her uterus (Ehrenreich and English 1978).

Now, women's mental statesare said to be at the mercy

of theirhormones.Bothmodels derive the natureof the

feminine psyche from bodily processes, and both con-

firmwhat Genesis firstproposed: hat it is women's na-

tureto suffer.Emily Martin(1987) 'has recently offered a provoca-

tive analysis of American PMS along Marxist lines.

She argues convincingly that the late industrial work-

place, demandingof the body ever-increasedwork effi-

ciency, is responsiblefor labelling as an illness the re-

duction in work energy that often accompanies the

premenstrualtime. PMS may well have become a

means, however unconscious, whereby women rebel

againstexcessive demandsplaced on them in the work-

place as well as the home.

I take as a given that PMS fits into late industrial o-

ciety in the ways Martin has proposed;but rather han

emphasizing political andeconomic aspectsI stress the

symbolic natureof American PMS complaintsin rela-

tion to accepted ideologies of the female personality Iassume that there is a normativepersonalityto whichwomen feel they shouldaspire,with the constructionof

self shapeddeeply by culture (cf. Rosaldo 1984, Lutz

1986). While I acknowledge that many women do not

fit or even aspire to the cultural deal (nor is PMS ex-2

periencedby all Americanwomen) I suggest that in-

dividualvariabilitydoes notnegatethe ideal.

My analysisdoes not take PMS as an 'imagined'dis-

ease - as Westerndoctors have tended to see women's

medical problems,a 'case of female nerves', or some-

thing that is 'all in the head' (Brown and Zimmer

1986). I acceptany symptomidentified by a sufferer as

real enough. What I focus on is the cultural construc-

tion of such symptoms (cf. Helman1987).

While comparativestudies of the menstrualexperi-

ence remainunderdeveloped, hereare hints that a cul-turally meaningful category of disease whose contours

would be roughly those of PMS are absent in at least

some of the world's cultures. Earlierthis centuryMar-

garet Mead (1928:113) wrote thatSamoan women may

feel some bodily discomfort while menstruatingbut do

not associate menstruation with other emotional

changes. More recently, MarjorieShostak has written

of !Kung women that despite having hormonal cycles

similarto Westernwomen (1981:353-4),The !Kung did not have any expectation or belief com-

parable to that held in the west of a premenstrualmen-

strual syndrome.Nor did they recognize any effect of the

menstrualcycle on women's moods or behavior . . . They

did associate physical discomfort with menstruation, spe-

cially with its onset, but this ... was described only inpractical erms, not in termsof wider psychological ramifi-

cations(1981:353).

Other societies in which the psychological component

of PMS would appearunlikely to find a place include

the Rungus of Borneo, the Beng of C6te d'Ivoire and

the Yurok of California (Buckley and Gottlieb 1988).

Because the physical changes associated with menstrua-

tion (abdominalcramps, lower back pain, etc.) appear

to be very widespread f not universal,while the mood

changes that are associated with PMS in America do

not seem to be found cross-culturally,I focus exclu-

sively on the psychologicaldimension,leaving aside as

a more purely biological matter the physical discom-

forts3.

I will be deliberatelyvague aboutdelimiting the dur-ation of PMS. In varying accounts its duration hasrangedin scope from one day to two weeks before the

onset of menses but in any case it begins after ovula-

tion occurs. I take 'premenstrual'to encompass that

amount of time that it is perceived to be relevant by

those women who report PMS symptoms. In other

words, I take PMS as a native category with a great

deal of flexibilityin its application.

Before the currentrage over PMS, it was the men-

strual period itself that was blamed for the negative

mood changes that we associate nowadays with PMS.

Nevertheless, many women - and men - still associate

menstruation tself with those negative mood changes.

Thus I am really discussing 'paramenstruum':he time

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Advertisementor

capsules, publishedby

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both preceding and encompassing the menstrualperiod

(typically lasting about ten days). But because in con-

temporary America 'PMS' has emerged as the core

term by which menstrual-related sychological distress4

can be explained, I echo currentusage4.

To anticipate my analysis, I shall propose that every

month the PMS sufferer inverts the explicitly valued

form of feminine personality o enact its opposite. This

monthly reversal is certainly disapprovedof by the cul-

ture, yet it is intrinsic to Western understanding f wo-manhood. Together, the two extreme styles of feminine

personality, as exhibited during the time preceding (and

encompassing) the menstrualperiod and during the rest

of the month, combine to produce a whole conception

of femaleness that s deeply embedded n ambivalence.

Women who suffer fromPMS say thatthey lose con-

trol, are seized with overpowering urges. What shape

do these urges take?As Martinhas pointed out, certain

themes emerge, especially with married women, who

by farpredominateamong PMS sufferers andare there-

fore the focus of this paper. Almost uniformly,these

urges are seen as negative traits both by the women

themselves and by the wider society (but for creative

re-shaping of these urges, see Martin 1987; Witt

1984:149-152; Rome 1986:146; and especially Shuttle

and Redgrove 1978). The urges have been grouped by

one doctor (Guy Abraham) nto two clusters, 'Type A'

(anxiety) and 'Type D' (depression) (in Trupin

1985:22),each encompassingseveralrelated symptoms.

As Type A moods seem by far to predominate (Ab-

raham'sestimate is 80%),I concentrateon those.

DuringPMS 'attacks', marriedwomen who are Type

A say that they 'rant and rave', especially to their

families. They become angryand 'lash out', particular-ly at their husbands but also their children. They are

critical andedgy for what they, and those around hem,

perceive as no reason other than 'the time of the

month'. Irritabilityand hostility are terms that recur in

descriptionsof PMS.

Let us consider the following statementby a PMS

sufferer in Witt 1984:133):About once a month, I'd become a different person. I

would yell, pick fights, become unbelievably aggressive. It

terrifies me. I don't like to think that's the way I am. I'm a

nice, quiet personthe rest of the month. But the days be-

fore my periodI feel like a monster.

In this lament, typical of descriptionsof PMS attacks,

the woman reportsthatpremenstrually he behaves in

This paper wasoriginally presentedat

the 86th Annual

Meeting of the

American

Anthropological

Associationin

November 1981

(Chicago)in a session

on 'Suffering and

Compassion'

(organizedby Thomas

Buckley). For their

comments as session

discussantsI thank

William Powers and

Robin Ridington.Jo

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an opposite manner to how women should behave nor-

mally according to mainstreamWestern standards.Of

what does this series of expectations consist? In the

words of the woman just quoted,women are - or long

to be seen as - 'nice' and 'quiet'. Impliedin 'nice' is

that they shouldbe kind, considerateof others,even al-

truistic (Adams 1971, Bardwick and Douvan 1971).

That these expectations are not merely cultural stereo-

types but actively internalized s borne out by studies

that show, for example, that American women smile

more than men do and interruptmen more rarelythan

the reverse(in Anderson 1983:48;also Lakoff 1975). Inthe private sphere, it is women who are supposed to

hold together the family, who 'make the house a home'

(Ehrenreichand English 1978)5. The home', identified

with women, even partakesof the sacred:a sanctuary o

which men can escape afterbeing pollutedby the sym-

bolic dirt of the workaday world (Rybczynski

1986:160). Correspondingly,n the public sphere, it is

women who conduct the vast majority of volunteer

work (Smith 1975:125).

There aremany reasons for this, includingeconomic

and political factors, but these are surely groundedin

the general tendency for women's 'nature' to be

defined aroundgiving to others for the sheer pleasure

of compassion (Gold 1971).

During most of the month, women should embody

the positivevirtuesjust summarized; et duringthe par-

amenstruum hey are permittedto play out what are

perceived widely as disapprovedmodes of behaviour,

not only sufferingbut also causing others to suffer by

revoking their normal compassion. In effect, they

reverse their 'normal' role. The typical woman is per-

mitted - even encouraged- to oscillate between two

personality extremes, which have been temporalized6

into specific chunks of the month . (One woman in a

PMS workshop I observed brought up the film Dr.

Jekyll and Mr.Hyde, thoughshe insisted that this bifur-

cation of personalitywas more extreme than her own.)

While we may see women during this time as acting

'abnormally', this model of behaviour is nevertheless

very much written nto a culturalscript.Taken together,

the two ends of the female personality spectrumoffer a

completerangeof experienceconsideredacceptablefor

women in America.

These attitudes are taught to women when quite

young: there is evidence that the expectationthat girls

will embodythis set of ideals appearsas early as birth.

The new mother in some American hospitals may be

given an information sheet entitled either 'What is a

Girl?' or 'What is a Boy?', as I was in April 1987, de-7

tailingthe natureof herbaby.

With this in mind, let us examine a portion of the

text for 'What is a Girl?', with its list of traits that

Americanfemales should embody. To put it at its most

succinct:Who else can cause you moregrief, joy, irritation, atisfac-

tion, embarrassment nd genuine delight than this combi-

nationof Eve, Salome and Florence Nightingale?

Here we have combined the extremes of feminine al-

lure: purity, seduction, plus selfless dedication to

others. The publication admits, delicately, that girls

have their imperfections, but these are relatively harm-

less:

Little girls are the nicest things that happen to people.

They are born with a little bit of angel-shine about them

and though it wears thin sometimes, there is always

enough left to lasso your heart - even when they are sit-

ting in the mud, or crying temperamentalears, or parading

up the street n mother's best clothes.

Herewe have the most positive image possible of girls:

the angelic. This, in spite of the occasional moodiness

or cute sources of exasperation hey might be. But let

us continue:A little girl can be sweeter (and badder) oftener than

anyone else in the world. She can jitter around,and stomp,

and make funny noises that frazzle your nerves, yet just

when you open your mouth, she stands there demure with

that special look in her eyes. A girl is Innocence playing in

the mud, Beauty standing on its head, and Motherhood

dragginga doll by the foot.

Now, a negative note is introduced.The girl can be'bad' - but note this is in parentheses, subsidiaryas it

were to sweetness. 'Motherhooddragginga doll by the

foot' is a compelling image: she can be irresponsibleas

a mother, but it's in innocence, and she can't be

blamed. By means of these tropes, the dual images of

extreme goodness and extreme badness are introduced

to girls literally at birth, via the expectations of their

new parents,who will be socializingthem. But always

the Good should subsumethe Bad, as in the grammati-

cal constructionused in the handout.

If socialization into this script begins at birth,it con-

tinues througha woman's life. Let us explore briefly

two examples of how instruction about PMS, specifi-

cally, teaches women about anticipatedmood shifts

from the 'nice' to the 'irritable'.

At adolescence a girl is intensely curious about her

changing body and seeks information about the trans-

formations. One source is her doctor's office. Widely

available in American paediatrician's offices are

booklets on various subjects, including menarche. One

such booklet, called 'To answer your questions about

your teenagemenstrualcycle' (printedby Personal Pro-

ducts Company) is in a question-and-answer ormat.

Here is one section:Sometimes I feel tired and moody. Does this have any-

thingto do with my cycle?

It may. Many things influence the way you feel. In some

cases your moods may be affected by your cycle. For

example,some girls and women eel tired and irritablea

week or so beforetheirperiods. Thismay be related to the

levels of hormonesin your blood during thepremenstrual

phase (Anonymous 986).

This publicationnot only puts physical ('tired') and

mental ('irritable') symptoms on the same level, but it

posits a direct, causal association between biological

processes (hormones) and mental states (moods). In so

doing, this booklet, teaching young girls whatto expect

from the (pre-)menstrualexperience, in effect instructs

them that 'PMS' (unnamed n the present instance)is a

naturaloccurrence.

Socializationinto psychological changes during par-

amenstruumcontinues through a woman's adulthood.

On a first visit to a gynaecologist's office an American

woman is usually asked to fill out a personal historysheet. Included n one sheet collected is the question:Do you have moodiness, depression, irritability,swelling

or bloating rior o yourmenstrualeriod?

As with the previous case, this question implies that

'moodiness', 'depression' and 'irritability' might be

normal or common during the premenstrual ime. Sec-

ondly, it puts these personality changes on a par with

the physical changes of 'swelling' and 'bloating', there-

by medicalizing the personality changes with an im-

plied biological foundation In filling out forms such

as these in their daily lives, American women are in ef-

fect told by 'experts' (who presumably construct such

forms) that negative moods experienced premenstrually

are indeed a medical problem and therefore perhaps to

Kibbee,Reference

Librarian t the University

of Illinois,graciously

suppliedbibliographic

suggestions.For

commentson the

manuscript, amvery

grateful o Clark

Cunningham,oAnn

D'Alisera, Emily Martin,

the anonymous eadersof

A.T., and,as ever, Philip

Graham.

1. I aim my analysis of

PMS at American ociety

but suggestthat the

generalconceptionof

femininepersonality

sketchedhere is pervasive

in Westerncultures for

Italysee Giovannini

1981). Though t exists as

a publiccategory,I have

not researchedhe specific

questionof PMS in

Europe butsee, for

example,Dalton 1980,

d'Orbanand Dalton 1980).

2. Estimatesvary

considerably,rom25%-100% Janigeret al.

1973:226).A recent

television report on local

CBSNews, 4/20/88)

claimed that'nearlyhalf'

of all Americanwomen

have some PMS

symptoms.

3. Janigeret al. (1973:232)

suggest tentatively hat

'premenstrual istressis a

universalphenomenon'

butacknowledgethattheir

field data were gathered n

less thanoptimalways

(p.229) and, in any case,

among only fivenon-American ulture

groups. I do not take their

conclusionas definitive.

4. Scepticalobserversof the

recent PMS phenomenon

may inquire,What did

women do beforePMS

was named?My answer is

thatthe symbolicplace

occupied by PMS in

women's lives nowadays,

as I analyseit in this

article,was previously

occupied by the menstrual

perioditself. A historical

analysisof the originsof

thatrelationship o the

menstrualperiodis surely

neededbut beyondthescope of the presentessay.

5. A trivial buttelling

example of this attitude s

imprintedon a Hallmark

cup with 'Mom sweet

Mom' on a background f

flowers, as a play on the

old saw, 'Home sweet

Home'.

6. For relatedItalian

conceptions of femininity

oscillating between the

virgin/Madonna nd the

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some degree inevitable. Furtherstudy of other widely

distributed pamphlets and questionnaires(as well as

school textbooks teaching about the female body) is

sorely neededto discover the extent to which these atti-

tudes are explicitly taught throughoutwide sectors of

theculture.

In any case, individual women have come to see cer-

tain states of mind as being due to PMS even when

there is no evidence to supportthis in their own par-

ticularhistories.One woman in a PMS workshopI ob-

served complained of headaches before, during and

after her menstrual period, but blamed them all on

PMS. Such attributionsof any negative states to PMS

are apparentlymade by women quite commonly. Som-

mer reportsthat women complainedof negative moods

associatedwith the premenstrualime, but later investi-

gation of the women's own diaries of their moods and

menstrualcycles revealedno such association (parallel

findings are cited in Frieze et al. 1978:201). On the

other hand there is a tendency among both men and

women to blame the menstrual cycle for negative

moods that do occur during the paramenstruumwhile

blaming other factors for negative moods that occur

duringothertimes (Sommer 1982:62). In other words,

the menstrualcycle is held responsiblefor as much as

possible even whenit

cannotpossiblybe held account-

able for all negativemoods. Sommerconfirmsthat ne-

gativemoods aretaughtto American women (andmen)

as a 'natural'componentof the paramenstrualime.

I have suggestedhow the negative moods thatdefine

PMS constitute the opposite of what is 'normally' ex-

pected of women in America. During PMS, the

idealized attributesare reversed temporarily.What is

the purposeof such a reversal,and what can it accom-

plish?

In writingof ritualsof reversal,the historian Natalie

Zemon Davis has pointed out (1978:152-153) that an-

thropologicalanalyses have emphasizedthe stabilizing

force that, paradoxically,they represent.In many Afri-

can and otherritualsof reversal,no real rebellionis ef-

fected or even attempted (e.g. Gluckman1963, 1965).The goal of the typicalritualof reversalas presentedby

anthropologistss not to topple the underlyingstructure

but to affirm it. During the ritual, the arbitrarinessof

the structuremay be acknowledged, implicitly or even

explicitly (Turner1967); but once the ritual s over, life

reverts to its prior state and continues as if uninter-

rupted.

Davis's own analysis of sexual reversals in early

modernEuropean iterature,art and street festivals of-

fers a contrastingperspective,as she shows the poten-

tially subversive natureof at least some sexual rever-

sals. In the case of AmericanPMS, is the reversal of

personality hatI have outlined,which might be termed

a 'ritual'9,essentially conservative or potentiallyradi-

cal? Does it maintain he existing ideals of feminine be-haviour(and, by extension, the configurationof power

relationsbetweenwomen andmen), or might it serve to

underminethat system of representationsand create a

new set of images and ideals to which women of the

future might aspire?I suggest that at presentPMS has

an essentially conservativeeffect because the hallmark

of PMS is to turn women's experience against them-

selves. B3y nflicting themselves on others, they them-

selves suffer.In termingtheir domesticacts of rebellion

'irritability',women are made to feel guilty for revers-

ing the normalexpectationsof them (Martin1987:134).

To what extent might PMS be seen as an 'escape

valve', a means whereby American women 'let off

steam' fromthe enervatingmachineof the daily domes-

tic grind?To some extent this explanation s valid, but

it tells only partof the story.It ignoresthe specific con-

tours of PMS and its predictable rajectory;moreover, t

puts PMS in a place that is peripheral o the American

vision of womanhood,whereas my contention is that

the currentunderstanding f PMS (and, before its cre-

ation, of the menstrualperiod itself) is integralto how

we view femininity.Even if it occupies a small portion

of women's lives (althoughsome women may see the

paramenstruums occupyinghalf the month),andeven

if not all women suffer from it, I contendthat the con-

temporaryvision of PMS is so much a partof general

culturalconsciousness that it constitutes, qualitatively,

half the female story.It combines with the otherpartof

the month to producea bifurcatedvision of femininity

whose two halves areasymmetricallyvalued.

Married women who suffer from PMS report that

duringthe 'normal'phaseof the monththey allow their

husband's myriad irritatingacts to go uncriticized. But

while premenstrualhey are hyper-criticalof such acts,

sometimes 'ranting and raving' for hours over trivial

annoyances.Unable to act 'nice' continually, women

breakdown and are regularly'irritable' and even 'hos-

tile'. Their protest is recurrentbut futile, for they are

made to feel guilty aboutit, or, worse, they are treated

condescendingly.'We both know you're going to have

your periodtomorrowso why don't we just go to bed?'

one husbandregularlytells his wife at the first sign of

an argument, herebydismissing any claim to legitimate

disagreement.Without legitimacy, as Weber taughtus

long ago, protests are doomed to failure;and so it is

with PMS.

I suggest that these women in effect choose, however

unconsciously,to voice theircomplaintsat a time that

they know those complaintswill be rejectedas illegit-

imate. If complaintswere made duringthe non-premen-

strual portion of the month, they would have to be

taken seriously. But many Americanwomen have not

founda voice with which to speaksuch complaintsand

at the same time retain their feminineallure.They save

theircomplaintsfor that 'time of the month' when theyare in effect permittedto voice them yet by means of

hormones do not have to claim responsibility for such

negative feelings. In knowing when their complaints

will not be taken seriously yet voicing them precisely

during such a time, perhaps women are punishing

themselves for their critical thoughts.In this way, and

despite the surface-level aggression they display

premenstrually,women continue to enact a model of

behaviourdoomed to failure,as is consistentwith what

some feminists have argued is a pervasive tendency

among American women in other arenas (Homer

1972).

So long as Americansociety recreates its unrealistic

expectationsof the female personality,it is inevitable

that therewill be a PMS, or something playing its role:a regular rejection of the stringent expectations of fe-

male behaviour. But PMS masks the protest even as it

embodies it: for, cast in a biological idiom, PMS ismade to seem an autonomous orce that is often uncon-

trollable (see Martin 1987:132-3); or of it can be con-

trolled, it is only by drugs not acts of personal volition.

Thus women's authorshipof their own states of mind is

denied them. As women in contemporaryAmerica

struggle to find their voices, it is to be hoped that they

will be able to reclaim their bodies as vehicles for the

creation of their own metaphors, rather than autono-

mous forces causing them to suffer and needing to be

drugged.

prostitute, ee

Giovannini 1981).

7. This was first printed

by the New England

Mutual Life Insurance

Co. The company

ceased distributingt

aboutten yearsago but

private ndividualsand

other agenciescontinue

to reprintand distribute

it in large quantities.

When New EnglandLife was distributing

the handouts, he

intentionwas thatthey

would 'pull on the

heartstrings' f new

parents,makingenough

culturalsense to them

that they would

purchase ife insurance

(LauraLock,

Advertising

Department,New

EnglandLife Insurance

Company:personal

communication, Nov.

1987).8. A strikinglyparallel

exampleof

somatizationof

psychological

symptoms s exhibited

in the following

descriptionof a PMS

sufferer: She had

breastpain,

bloatedness,and

frequently tarted

argumentswith her

husband' Witt

1984:41).

9. As outlined by Turner

(1967:95) the essential

feature of ritual s thatthe identityof the

participantss

transformed

permanently,he most

famous instancebeing

ritualsof initiation.By

this definition,PMS as

I understandt would

not be a ritual,as its

hallmark s that the

monthlytransformation

is both regularand

reversible: ew women

would like to become

permanentlyhe

womenthey areduring

thepremenstrual(and/ormenstrual)

phase.Yet I suggestthere is an intermediate

form of ritual n which

personal dentity s

transformed,butonly

temporarily,and then

reverts to earlier

structuresGottlieb

n.d.). As I have

analysed it, PMS would

seem to be a perfect

example of such an

intermediary ormof

ritual.

ANTHROPOLOGYTODAY Vol 4 No 6, December1988 13