Thinking ‘crazy’: DSM5 and women’s periods

I have been trying to get the word “crazy” out of my daily vocabulary.  I tend to use it to mean something surprised me, and that seems to be a little insensitive and it doesn’t actually convey what I’m trying to communicate.

But the American Psychiatric Association actually publish a book that defines mental illnesses/disorders in the US: the DSM.  This is the authority that creates new disorders that get wide-spread pharmaceutical advertisements.  This is where new diseases are constituted and where old disorders are reorganized.

It is the DSM’s that have first labelled gay sexual desire as being a mental illness later to change their mind after years of shock therapy.

We should be clear that the development of labels for mental illness come with material impacts.  When we name human beings as ill, we also submit them to treatment or scorn.  This is the development of societal exclusion and hierarchy in visible language.  Creating the category of treatment is itself a displacement of individual voice and experience.

According to the LA Times, a posse of psychiatrists are meeting in Hawaii and debating the creation of new categories of mental illness for addition into the fifth edition of the DSM.  In addition to deciding that gambling, obesity, and a few other clunky new categorizations of human behavior  are apparently driven by mental illness they are wondering whether:

• Is there a distinct mood disorder that occurs in some women prior to their periods?

• Is hoarding a brain-based illness?

• Can the sorrow accompanying bereavement swell into a certifiable mental disorder?

via Psychiatric disorders: Deadline nears for next edition of diagnostic manual – latimes.com.

Pretty interesting questions.  I wish folks could investigate these questions without the goal being to come up with a crisp ‘diagnosis’ for medication, treatment and ‘cure.’

Noting that the article says that the DSM5 draft is is visible, I swung by to see about the return of “Premenstrual dysphoric disorder” (the ‘mood disorder’ referred to by the LA Times) in the next draft of the DSM.   The draft has a handy rationale with some interesting ideas visible. Here is the bottom two paragraphs from their rationale.

It should also be mentioned that there is already some acceptance for PMDD as an independent category from Federal regulators in that several medications have received an indication for treatment of PMDD.

There may be concerns on the part of some stakeholders that this category is proposed as a new diagnosis. In particular, some groups have felt that a disorder that focuses on the perimenstrual phase of the menstrual cycle may “pathologize” normal reproductive functioning in women. Relatedly, only women are at risk for the condition and this may be of concern to some in that they feel women may be inappropriately stigmitized. Some women’s health advocates were concerned that designation of a category for PMDD would insinuate that women are not able to perform needed activities during the premenstrual phase of the cycle. Our group reviewed this literature. We felt that the prevalence statistics clearly indicate that PMDD is a condition that occurs in a minority of women. As such, it would be inappropriate to generalize any disability to women in general. In fact, a DSM diagnostic category for women who experience marked symptoms and impairment perimenstrually highlights the fact that most women do not experience such symptoms. Analogously, while most individuals experience the feeling of sadness at some point in their lives, not all individuals have experienced a mood disorder.

via APA DSM-5 | D 04 Premenstrual Dysphoric Disorder.

1.  They are making the case to return this disorder to the mental illness book because “federal regulators” have already released drugs to treat this condition.   If there was ever a visible moment of the medicine before the disease, this is a pretty good one.

2.  The second paragraph is a stunningly avoidance of what seem to me to be some pretty good arguments.  If most women have periods and some of them come with discomfort, this official diagnosis expands the risk that women will think that their normal period is messed up.   In essence, these criticisms point to the difficulty in discovering whether you are experiencing “marked symptoms and impairment perimenstrually”or just having a rough period.

Now, I’m not a Psychiatrist.  But I looked at the list to see if I could distinguish what the “bright-line” was between having a period and having “premenstrual dysphoric disorder.   Well, you are supposed to have five or more of the symptoms a week before menstruation and then they clear up after your period is over.

As near as I can tell, five of them are vague descriptions of moods rather than physiological experiences. If you felt bummed, blue, depressed, alienated, sad, or frustrated at the patriarchy during your period and your boobs hurt, you’d easily trigger a diagnosis of this “disorder.”

(1) marked affective liability (e.g., mood swings; feeling suddenly sad or teaful or increased sensitivity to rejection)

(2) marked irritability or anger or increased interpersonal conflicts

(3) markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

(4) marked anxiety, tension, feelings of being “keyed up” or “on edge”

(5) decreased interest in usual activities (e.g., work, school, friends, hobbies)

(6) subjective sense of difficulty in concentration

(7) lethargy, easy fatigability, or marked lack of energy

(8) marked change in appetite, overeating, or specific food cravings

(9) hypersomnia or insomnia

(10) a subjective sense of being overwhelmed or out of control

(11) other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain

via APA DSM-5 | D 04 Premenstrual Dysphoric Disorder.

(Please note the typo of what I assume is supposed to read “tearful” in the first symptom description from the original site.  I wonder if someone who needs Earl Grey to get moving in the morning might mistakenly be diagnosed with this disorder because they were too “teaful.” )

Like horoscopes which are written with such vagueness as to apply to almost everyone, these descriptions can only help to lock in a sexist understanding of women themselves.  Like the phrase “she’s PMSing” used as a way to dismiss criticisms from women, if women cede the ground to the psychiatrists to define that their very cycle itself makes women sick, then the cultural impact will be massive.

Now, lets be super clear — I think that menstruation is a different experience for different women.  And I don’t mean for this discussion to suggest that some women don’t really hurt during their periods.  Many women find that their periods are enormously painful.  Inga Muscio’s wonderful book Cunt provided me with some thoughtful perspective on menstruation and the relationship between the labelled women’s body and that pain.   She notes that she appreciated the medical research discovering that women actually hurt during menstruation.

After all those days I vomited because the mid-section of my body was clenched in a fist of throbbing excruciation; when I sat in the bathtub crying for five hours straight; when I couldn’t get out of bed or leave the house for fear of fainting in public; suddenly, because a group of men took the time to study a group of women and found there was indeed a rational reason for these symptoms to wrack our bodies once a month, I was allotted the pale comfort of knowing this pain actually existed!

Oh Joy.

Cynic that I am in such arenas of contemplation, I wonder if perhaps this generous allotment wasn’t bestowed upon womankind because pharmaceutical companies came to the magnanimous conclusion that sales for pain relievers would skyrocket if only they invested in a little “research” to counter the “in her mind” myth and re-condition the general public into believing there was a veritable malady at hand.

– Inga Muscio, Cunt. p. 20

And of course, here is Prozac maker Eli Lilly pulling the PMDD description from UK prozac because “. . . it is not a well-established disease entitity across Europe.”