Robyn Stein DeLuca: The good news about PMS

翻译人员: chunhua zhang 校对人员: Karen SONG

How many people here have heard of PMS?

在座各位有多少听说过经前综合征？

Everybody, right?

所有人都听说过，对吗？

Everyone knows that women go a little crazy

大家都知道女人在月经来潮前

right before they get their period,

会变得有点狂躁，

that the menstrual cycle throws them onto an inevitable hormonal roller coaster

这种生理周期将她们拋上一架 无法避免的荷尔蒙过山车，

of irrationality and irritability.

满载着不理性和易怒。

There's a general assumption

这里有个普遍的假设，

that fluctuations in reproductive hormones cause extreme emotions

就是生殖激素的波动会导致极端情绪，

and that the great majority of women are affected by this.

大多数女性都会受此影响。

Well, I am here to tell you that scientific evidence says

而在这里要告诉你们，有科学证据表明，

neither of those assumptions is true.

以上假设并不成立。

I'm here to give you the good news about PMS.

我来这儿是要你们带来些 关于经前综合症的好消息。

But first, let's take a look at how firmly the idea of PMS

但是首先，让我们来看一下 经前综合征的观念

is entrenched in American culture.

在美国文化中是多么的根深蒂固。

If you examine newspaper or magazine articles,

如果你去查阅报刊杂志中的文章，

you'll see how widely assumed it is that everyone gets PMS.

就会发现”每个女人都有经前综合征“ 这个假设有多么普遍。

In an article in the magazine Redbook titled "You: PMS Free,"

REDBOOK杂志有一篇文章， 标题为《你：从经前综合征解放》，

readers were informed that between 80 to 90 percent of women suffer from PMS.

读者被告知80%到90%的女性 都为经前综合征所扰。

L.A. Muscle magazine warned its readers

L.A. Muscle杂志警告它的读者，

that 40 to 50 percent of women suffer from PMS,

40%到50%的女性有经前综合征，

and that it plays a major role in women's mental and physical health,

并且它主导着女性的身心健康。

and a couple of years ago, even the Wall Street Journal

几年前，甚至《华尔街日报》 也刊登过一篇文章，

ran an article on calcium as a treatment for PMS,

介绍经前综合征的钙疗法，

asking its female readers,

并且向其女性读者设问：

“你每月都会变女巫吗？”

"Do you turn into a witch every month?"

From all these articles, you would think there must be a mountain of research

通过所有的这些文章，你可能会认为 应该已经有小山一般的大量研究

verifying the widespread nature of PMS.

证实了经前综合征普遍存在的本质。

However, after five decades of research,

然而，经过50年的研究，

there's no strong consensus on the definition, the cause,

人们并没有在对经前综合征的 定义、起因、疗法

the treatment, or even the existence of PMS.

甚至它本身是否存在等方面 达成强有力的共识。

As most commonly defined by psychologists,

按照心理学家最常用的定义，

PMS involves negative behavioral, cognitive and physical symptoms

经前综合征包含了负面的行为、认知 和身体上的一系列症状，

from the time of ovulation to menstruation.

从排卵期延续到月经期。

But here's where it gets tricky.

但它的棘手之处在于

Over 150 different symptoms have been used to diagnose PMS,

有超过150种不同的症状 被用来诊断经前综合征，

and here are just a few of those.

这里列举了其中一些。

Now, I want to be clear here.

我想澄清一点，

I'm not saying women don't get some of these symptoms.

我不是说女性不会出现这些症状，

What I'm saying is that getting some of these symptoms

而是说即使出现了其中一些症状，

doesn't amount to a mental disorder,

也不意味着就有精神障碍，

and when psychologists come up with a disorder

而当心理学家提到精神障碍时，

that's so vaguely defined,

这是一个很模糊的定义，

the label eventually becomes meaningless.

所以这个标签也就变得毫无意义了。

With a list of symptoms this long and wide,

按照这么一份冗长的、 涵盖甚广的症状清单，

I could have PMS, you could have PMS,

经前综合征我可能有、你可能有、

the guy in the third row here could have PMS,

坐第三排那位男士可能有、

my dog could have PMS. (Laughter)

我的狗也可能有。（笑声）

Some researchers said you had to have five symptoms.

有些研究员说， 你必须同时满足五条症状，

Some said three.

而另一些人说只要三条。

Other researchers said that symptoms were only meaningful

有些研究员说， 只有当那些症状严重到会

if they were highly disturbing to you,

干扰你的正常生活时才有意义，

but others said minor symptoms were just as important.

但另一些人又说， 即使症状轻微也一样。

For many years, because there was no standardization

多年来，因为没有一个

in the definition of PMS,

对经前综合征的标准定义，

when psychologists tried to report prevalence rates,

所以当心理学家尝试去报告患病率时，

their estimates ranged from five percent of women

他们的估算从5%

to 97 percent of women,

到97%的女性不等，

so at the same time almost no one and almost everyone had PMS.

也就是说在同时，要么几乎没人有经前综合征， 要么几乎人人都有。

Overall, the weaknesses in the methods of research on PMS have been considerable.

总的来说，这些经前综合征的 研究方法有相当大的弊端。

First, many studies asked women to report their symptoms retrospectively,

首先，很多研究要求女性 回溯报告她们的症状，

looking to the past and relying on memory,

回顾过去，仰赖记忆，

which is known to inflate reporting of PMS

我们已知这种方法会夸大事实；

compared to what's called prospective reporting,

与之相较的另一种方法叫做前瞻性报告，

which involves keeping a daily log of symptoms

被测者要每天记录发生的症状，

for at least two months in a row.

至少持续两个月的时间。

Many studies also exclusively focused on white, middle-class women,

还有很多研究仅关注中产阶级白人女性，

which makes it problematic to apply study findings to all women.

而把研究成果应用到所有的女性时， 就会产生问题。

We know there's a strong cultural component to the belief in PMS

我们知道关于经前综合征的观点 存在有很强的文化要素，

because it's nearly unheard of outside of Western nations.

因为它在西方国家之外几乎闻所未闻。

Third, many studies failed to use control groups.

第三，很多研究并没有使用对照组。

If we want to understand the specific characteristics

如果我们想要了解

那些患经前综合征的女性有何特征，

of women who have PMS,

we need to be able to compare them to women who don't have PMS.

我们需要能够将她们 与没有经前综合征的女性作对比。

And finally, many different types of questionnaires were used

最后一点，很多不同类型的 用于诊断经前综合征的调查问卷

to diagnose PMS, focusing on different symptoms,

聚焦于不同的症状、

symptom duration and severity.

症状持续的时间和严重性。

To do reliable research on any condition,

无论在任何条件下，可靠的研究

scientists must agree on the specific characteristics

都要求科学家必须就构成这种条件的

that make up that condition

特征达成一致，

so they're all talking about the same thing,

这样才能确保讨论的是同一个概念，

and with PMS, this has not been the case.

但对于经前综合征来说，情况并非如此。

However, in 1994,

然而，在1994年，

the Diagnostic and Statistical Manual of Mental Disorders,

《精神障碍诊断与统计手册》，

known as the DSM, thankfully --

又被称作DSM——

it's also the manual for mental health professionals --

它也是一本供心理健康专业人员 使用的手册——

they redefined PMS as PMDD,

将经前综合征（PMS）重新定义为PMDD：

Premenstrual Dysphoric Disorder.

即经前焦虑障碍。

And dysphoria refers to a feeling of agitation or unease.

而其中的焦虑指的是一种 烦躁或不安的情绪。

And according to these new DSM guidelines,

根据这些新的DSM指南，

in most menstrual cycles in the last year,

（患有经前焦虑障碍的人） 上一年大多数月经周期中

at least five of 11 possible symptoms

在11种可能的症状中至少有5种

must appear in the week before menstruation starts;

应当出现在月经开始前的一个星期；

the symptoms must improve once menstruation has begun;

这些症状在月经开始后应当好转；

and the symptoms must be absent the week after menstruation has ended.

然后在月经结束后一个星期内消失。

这些症状必须包含下列四种之一：

One of these symptoms must come from this list of four:

marked mood swings, irritability, anxiety, or depression.

明显的情绪波动、易怒、焦虑、或抑郁。

The other symptoms could come from the first slide

其它症状可能包含于第一张

or from those on the second slide,

或者第二张幻灯片中的所列项，

including symptoms like feeling out of control

包括感到情绪失控，

and changes in sleep or appetite.

以及睡眠或胃口的改变。

The DSM also required now that the symptoms

DSM现在还要求这些症状

should be associated with clinically significant distress --

应该与临床上显著的痛苦相联系——

there should be some kind of disturbance in work

应当对工作、

or school or social relationships --

学习或者人际关系形成干扰——

and that symptoms and symptom severity should now be documented

这些症状及其严重程度应当反映在

by keeping a daily log for at least two cycles in a row.

至少连续两个周期的日志记录中。

And finally, the DSM required that the emotional disturbance

最后，DSM要求情绪障碍

should be more than simply an exacerbation of an already existing disorder.

应当不仅仅是简单的某种 已经存在的障碍的恶化。

So scientifically speaking, this is an improvement.

所以从科学上讲，这是一个进步。

We now have a limited number of symptoms,

现在我们有了数量有限的症状，

and a high impact on functioning that's required,

并且要求对正常生活产生显著影响，

and the reporting and timing of symptoms have both become very specific.

对症状的描述和发生时间也做了详细规定。

Well, using this criteria

运用这个准则，

and looking at most recent studies,

并且参照最近的研究，

we see that on average,

我们看到平均来说，

three to eight percent of women suffer from PMDD.

3%到8%的女性患有经前焦虑障碍。

Not all women, not most women,

不是所有的女性，也不是大部分的女性，

not the majority of women, not even a lot of women:

不是大多数女性，甚至也不是很多女性：

three to eight percent.

只有3%到8%。

For everyone else, variables like stressful events or happy occasions

对其他人来说，像导致压力的事件， 令人愉悦的场合，

or even day of the week

甚至是一周当中任何一天这样的变量，

are more powerful predictors of mood than time of the month,

都是比生理期更强大的情绪预测因子，

and this is the information the scientific community has had

而这也是科学界从1990年代

就已获得的信息。

since the 1990s.

In 2002, my colleagues and I published an article

2002年，我和同事们发表了一篇文章

describing the PMS and PMDD research,

描述对经前综合征和 经前焦虑障碍的研究，

and several similar articles have appeared in psychology journals.

还有其它几篇类似的文章 出现在心理学期刊上。

The questions is, why hasn't this information trickled down to the public?

问题是，为什么这些信息没有惠及大众？

Why do these myths persist?

为什么这些迷思仍然持续？

Well, certainly the onslaught of messages that women receive

当然，女性从书本、电视、电影和网络上

from books, TV, movies, the Internet, that everyone gets PMS

接受到的大量的宣称每个人 都会得经前综合征的信息，

go a long way in convincing them it must be true.

对于使她们确信那就是真相 起了很大的作用。

Research tells us that the more a woman believes that everyone gets PMS,

研究表明，一个女性越是相信 每个人都会有经前综合征，

the more likely she is to erroneously report that she has it.

她就越会错误地认为自己也有这种病。

Let me tell you what I mean by "erroneously."

让我来告诉你我所说的 “错误地”是什么意思。

You might ask her, "Do you have PMS?"

你可能会问她，“你有经前综合征吗？”

and she says yes,

她会回答：“是的。”

but then, when you have her keep a daily log

但是，当你检查她写的

连续两个月的心理症状日志时，

of psychological symptoms for two months,

no correlation is found between her symptoms

却无法找到这些症状

and time of the month.

跟生理期之间的关联。

Another reason for the persistence of the PMS myth

另一个经前综合征迷思仍然持续的原因，

has to do with the narrow boundaries of the feminine role.

是跟女性角色的狭窄边界有关。

Feminist psychologists like Joan Chrisler

像琼·克莱斯勒这样的女权主义心理学家

have suggested that taking on the label of PMS

曾经提出，贴上了经前综合征的标签后

allows women to express emotions that would otherwise be considered unladylike.

可以让女性有借口表现出一些情绪， 而这些情绪往往被认为是不够淑女的。

The near universal definition of a good woman

有一个对于“好女人”的 近乎放之四海皆准的定义，

is one who is happy, loving, caring for others,

她要快乐、充满爱心、关心他人、

and taking great satisfaction from that role.

并且对这种角色设定感到非常满意。

Well, PMS has become a permission slip to be angry, complain, be irritated,

这样一来，经前综合征就成为了一个 允许她们正当地发怒、抱怨、烦躁，

without losing the title of good woman.

却不会失去“好女人”的称号。

We know that the variables in a woman's environment

我们知道一个女性所处环境的变量

are much more likely to cause her to be angry than her hormones,

要比她的荷尔蒙更容易导致她愤怒，

but when she attributes anger to hormones,

但是当她把这种愤怒情绪 归咎于荷尔蒙时，

she's absolved of responsibility or criticism.

就无须为此负责，还能避免批评。

"Oh, that's not who she is. It's out of her control."

“哦，那不是真正的她，她控制不了。”

And while this can be a useful tool, it serves to invalidate women's emotions.

尽管这可以当做一种实用工具， 实际上却否定了女性的情绪。

When people respond to a woman's anger

当人们对一个女性的愤怒作出回应时，

with the thought, "Oh, it's just that time of the month,"

他会想，“噢，这只是生理期的原因。”

her ability to be taken seriously or effect change is severely limited.

她通常就不会被认真对待， 也不太可能会发生有益的改变。

So who else benefits from the myth of PMS?

那么还有谁能从经前综合征的 迷思中获益呢？

Well, I can tell you that treating PMS

我可以告诉你们，经前综合征的治疗

has become a profitable, thriving industry.

已经发展成一个有利可图、 蓬勃发展的行业。

Amazon.com currently offers over 1,900 books on PMS treatment.

目前，亚马逊网站上有超过1900种 关于治疗经前综合征的书籍在售。

A quick Google search will bring up a cornucopia

通过谷歌，可以很快搜索出一箩筐的信息，

of clinics, workshops and seminars.

全是关于诊所、讲习所和研讨会的。

Reputable Internet sources of medical information

那些著名的医学信息资源网站

like WebMD or the Mayo Clinic list PMS as a known disorder.

如“网络医生”、“梅约诊所”都将 经前综合征列为一种已知的精神障碍。

It's not a known disorder, but they list it.

它不是一种已知的精神障碍， 却被列为一种。

And they also list the medications that physicians have prescribed to treat it,

他们还列出了内科医生治疗 经前综合征的处方药，

like anti-depressants or hormones.

比如抗抑郁剂或者激素。

Interestingly, though, both websites say that the success of medication

有趣的是，这两家网站都表示 药物治疗经前综合征的

in treating PMS symptoms vary from woman to woman.

成功率因人而异。

Well, that doesn't make sense.

而这完全不合常理。

If you've got a distinct disorder with a distinct cause,

如果你得了一种由确切原因 导致的明显的精神疾病，

which PMS is supposed to be,

假设那就是“经前综合征”，

then the treatment should bring improvement for a great number of women.

那么针对它的治疗方法应该 为大量的女性带来病情改善。

This has not been the case with these treatments,

但是对于经前综合征的这些治疗方法 却并不是这么回事，

and FDA regulations say that for a drug to be deemed effective,

而且，美国食品和药品管理局的法规规定， 如果要认定一种药物有效，

a large portion of the target population

那么它的目标人群中的很大一部分，

should see clinically significant improvement.

应当有临床上的显著改善。

So we have not had that at all with these so-called treatments.

而我们从经前综合征的 所谓“治疗”上并未看到上述效果。

However, the financial gain of perpetuating the myth

然而，坚持宣扬经前综合征是一种

that PMS is a common mental disorder

可治疗的普遍的精神疾病这一谬见，

and is treatable is quite substantial.

所获得的经济收益是巨大的。

When women are prescribed drugs like anti-depressants or hormones,

当女性服用抗抑郁剂或激素等处方药时，

medical protocol requires that they have physician follow-up every three months.

医疗协议要求她们每三个月复诊，

That's a lot of doctor visits.

那是一个很大的就医量。

Pharmaceutical companies reap untold profits

医药企业能获取数不清的利润，

when women are convinced they should take a prescribed medication

只要女人们相信她们应该在

for all of their child-bearing lives.

整个怀孕期间服用处方药。

Over-the-counter drugs like Midol

非处方药像痛经药Midol

even claim to treat PMS symptoms like tension and irritability,

甚至声称能够治疗像紧张和易怒 这样的经前综合征症状，

even though they only contain a diuretic, a pain reliever

尽管它们只含有利尿剂、止痛剂

and caffeine.

和咖啡因。

Now, far be it from me to argue with the magical powers of caffeine,

我没有立场去争论咖啡因的神奇力量，

but I don't think reducing tension is one of them.

但我并不认为它有缓解紧张的作用。

Since 2002, Midol has marketed a Teen Midol to adolescents.

自2002年以来，Midol为青少年市场 开发了适用的产品，

They are aiming at young girls early,

他们早早的就瞄准了年轻女孩，

to convince them that everyone gets PMS and that it will make you a monster,

说服她们相信每个人都会得经前综合征， 那会使你变成一个怪物，

but wait, there's something you can do about it:

但是等一等，你还是有救的：

Take Midol and you will be a human being again.

服用Midol，就会变回正常人。

In 2013, Midol took in 48 million dollars in sales revenue.

2013年， Midol获得了 4800万美元的销售收入。

So while perpetuating the myth of PMS has been lucrative for some,

维持关于经前综合征的迷思对 某些机构来说是有利可图的，

it comes with some serious adverse consequences for women.

但是对女性自己 则会产生严重的不良后果。

First, it contributes to the medicalization

首先，它会导致

of women's reproductive health.

女性生殖健康的医疗化。

The medical field has a long history of conceptualizing

医疗领域有一个很长的历史，

women's reproductive processes as illnesses that require treatment,

将女性的生殖过程概念化为 一个需要治疗的疾病，

and this has come at many costs, including excessive Cesarean deliveries,

这样就会产生很多的花费， 包括过度的剖腹产手术、

hysterectomies and prescribed hormone treatments

子宫切除和指定的激素治疗，

that have harmed rather than enhanced women's health.

而这对女性的健康来说 有百害而无一利。

Second, the PMS myth also contributes to the stereotype of women

第二，经前综合征的迷思对女性

as irrational and overemotional.

不理性和过度情绪化的刻板印象的 形成有所助益。

When the menstrual cycle is described as a hormonal roller coaster

当生理周期被描述成将女性

that turns women into angry beasts,

变成愤怒的野兽的荷尔蒙过山车时，

it becomes easy to question the competence of all women.

就会很容易让人去怀疑 所有女性的能力。

Women have made tremendous strides in the workforce,

女性在职场上取得了巨大的进步，

but still there's a minuscule number of women at the highest echelons

但是在政府或者企业的高层职位中

of fields like government or business,

女性的数量仍然微不足道，

and when we think about who makes for a good CEO or senator,

当我们思考谁能成为 一个好的CEO或者议员，

someone who has qualities like rationality, steadiness, competence

那些拥有理性、稳重、能力等素质的人

come to mind,

会出现在我们脑海中，

and in our culture, that sounds more like a man than a woman,

而在我们的文化中， 男性听起来更符合这些条件，

and the PMS myth contributes to that.

而经前综合征的迷思正是 导致这种认知的原因之一。

Psychologists know that the moods of men and women

心理学家认为男性和女性情绪上的

are more similar than different.

相同之处多过差异。

One study followed men and women for four to six months

有一项研究对男性和女性 进行了4到6个月的跟踪，

and found that the number of mood swings they experienced

发现他们经历的情绪波动的次数

and the severity of those mood swings were no different.

和严重性并没有什么不同。

And finally, the PMS myth keeps women from dealing

最后，经前综合征迷思 妨碍到女性处理

with the actual issues causing them emotional upset.

那些造成她们心烦意乱的症结问题。

Individual issues like quality of relationship or work conditions

人际关系和工作环境的质量等个人问题，

or societal issues like racism or sexism or the daily grind of poverty

或者种族主义、性别歧视、 贫困折磨等社会问题，

are all strongly related to daily mood.

都跟每天的情绪有密切关联。

Sweeping emotions under the rug of PMS

用经前综合征来逃避情绪问题，

keeps women from understanding the source of their negative emotions,

限制了女性去了解她们负面情绪的来源，

but it also takes away the opportunity to take any action to change them.

同时也夺走了她们采取行动 去做出改变的机会。

So the good news about PMS

所以关于经前综合征的好消息是

is that while some women get some symptoms because of the menstrual cycle,

虽然一些女性会因为生理周期 而出现一些症状，

the great majority don't get a mental disorder.

但大多数的女性并不因此而患精神疾病。

They go to work or school, take care of their families,

她们照样工作、上学、照顾家庭，

and function at a normal level.

一切如常。

We know the emotions and moods of men and women

我们知道男性与女性的情绪和心情

are more similar than different,

极为相近，

so let's walk away from the tired old PMS myth of women as witches

那么就让我们从陈腐的视女性为巫婆的 经前综合征迷思中走出来，

and embrace the reality of high emotional and professional functioning

而去接受大多数女性 每天都过着情绪高涨、专业有序，

the great majority of women live every day.

运转正常的生活这一事实。

Thank you.

谢谢。

(Applause)

（掌声）