Let’s try a thought experiment.
Imagine if I asked if erectile dysfunction is real or is it socially constructed. I might write something like this:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Bures exemplifies a culturally mediated response that has existed since time out of mind: ignoring women’s symptoms.[/pullquote]
Erectile dysfunction is widely accepted to be a real disorder and there is an entire industry devoted to treating it with everything from medications to mechanical devices. But does erectile dysfunction reflect biological causes or is it figment of our sex ambivalent culture and men’s embrace of traditional gender roles?
You’d probably think I was nuts. Then you’d have some idea how I (and many other women) feel about author Frank Bures’ piece in Slate Is PMS real? Or is it a figment of our menstruation fearing culture?
Bures was researching culture specific syndromes:
Eventually this path led me back to my own culture, and to our own syndromes that don’t occur in other cultures. Premenstrual syndrome was near the top of this list. And much of what I read suggested that PMS was not caused by a tide of hormones wreaking havoc on a woman’s psyche, as I’d always believed…
He claims that PMS is social constructed:
… meaning it’s an imaginary condition foisted on women by society, which is another way of saying PMS is “not real.” Yet just because something is a social construction does not mean we don’t experience it—it simply means that our “real” physiological symptoms can have roots in our mind as well as our body.
Bures is wrong.
Part of the problem is that Bures conflates “culturally constructed” and “culturally mediated.” For example, Bures quotes several studies to support his contention.
Others have elaborated on PMS’s problematic nature as an evidence-based biological condition. Researchers Lisa Cosgrove and Bethany Riddle found that women who endorsed traditional gender roles experienced more menstrual distress. “One of the most striking results,” they wrote, “was that PMS discourse has gained such cultural currency that women often expect to have PMS.” Another study found that patients “firmly believed that PMS is biologically based, and they rejected situational attributions for their distress.” In another experiment, women who were misled to believe they were premenstrual experienced more symptoms of PMS than those who were actually premenstrual but who were misled to believe they were not.
But these studies don’t demonstrate that PMS is culturally constructed, merely that the way women experience and talk about their symptoms can be culturally mediated. The fact that the response varies among cultures is not proof that the syndrome itself exists only in the minds of its sufferers.
Indeed, the response to any condition, be it premenstural syndrome or erectile dysfunction is inevitably culturally mediated. A striking example occurs in the case of leprosy. The term “leper” originally meant someone who was suffering from leprosy (Hansen’s disease), a disfiguring condition that has long been met with social rejection. The term has come to mean a person who is avoided or rejected for moral or social reasons and that’s particularly apt when you consider that Hansen’s disease is not particularly contagious. Nonetheless, it was culturally perceived as punishment and in many ways people feared it more than an illness like tuberculous, which is far more common, more contagious and more deadly.
Yes, the response to leprosy has been culturally mediated, but that doesn’t mean that leprosy itself isn’t an organic syndrome. Similarly, while the response to PMS may be culturally mediated, it doesn’t mean that it is any less an organic syndrome than leprosy itself.
Ironically, in arguing that PMS is culturally constructed as opposed to culturally mediated, Bures exemplifies a different culturally mediated response that has existed since time out of mind, the culturally mediated response of men in discounting women’s symptoms, especially pain.
Bures alludes to this history before unwittingly adding to it. Bures explains:
In our own culture, the underlying idea behind PMS can be traced back 2,500 years to Hippocrates, the father of Western medicine, who believed that certain moods and physical disorders in women were caused by “hysteria” or the “wandering uterus,” meaning the organ literally drifted around the body, pulled by the moon, lodging in wrong places, blocking passages, causing pressures. Cures included marriage and intercourse, which supposedly worked. This notion endured for eons. But by the early 1900s, medical theories around “hysteria” were beginning to crumble. In 1908, at the meeting of the Societé de Neurologie in Paris, Joseph Babinski argued that hysteria was “the consequence of suggestion, sometimes directly from a doctor, and more often culturally absorbed.”
Hyster is the Latin word for uterus. Women’s ailments were traditionally classed as hysteria and thought to be caused by the uterus. But the fact that hysteria does not exist does NOT mean that the symptoms they were meant to describe did not exist. Hysteria provided a scientific sounding nomenclature by which to dismiss women’s real physical and psychiatric symptoms.
The diagnosis of hysteria may have disappeared but the cultural impulse to ignore women’s symptoms persists to this day. It is well established that women’s symptoms, particularly pain, are notoriously undertreated when compared to men’s symptoms. Women in agony are deemed to be “hysterical” while men are simply treated with the relevant medication or procedure.
Sadly, Bures is committing the same error in questioning the existence of PMS.
