Robyn Stein DeLuca: The good news about PMS

譯者: Regina Chu 審譯者: Simon Sun

How many people here have heard of PMS?

有多少人聽過經前症候群 (PMS)？

Everybody, right?

大家都聽過，對吧？

Everyone knows that women go a little crazy

大家都知道女人在月經來之前

right before they get their period,

會有點發神經，

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

月經週期讓她們坐上 無可避免的荷爾蒙導致的

of irrationality and irritability.

不理性與易怒的雲霄飛車。

There's a general assumption

有個很普遍的說法，

that fluctuations in reproductive hormones cause extreme emotions

說生殖荷爾蒙波動 會造成極端的情緒，

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

而且絕大部分婦女都受此影響。

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

嗯，我在這裡告訴大家 科學證據顯示

neither of those assumptions is true.

這兩個說法都不對。

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

我要在這裡宣布 經前症候群的好消息。

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

但首先來看一下 經前症候群這個說法

is entrenched in American culture.

有多麼深植於美國文化。

If you examine newspaper or magazine articles,

如果你檢視報章雜誌的文章，

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

你就會發現大家都以為 每個人都有經前症候群。

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

女性雜誌《紅書》有篇文章標題為： 「妳！從經前症候群釋放吧！」

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

文章告訴讀者約有八九成的女性 為經前症候群所苦。

L.A. Muscle magazine warned its readers

倫敦保健食品雜誌則警告讀者

that 40 to 50 percent of women suffer from PMS,

有四到五成的婦女 為經前症候群所苦，

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

而且這還在女性的身心健康 扮演重要角色，

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

而在幾年前，甚至華爾街日報

ran an article on calcium as a treatment for PMS,

也有篇文章在談 鈣質如何治療經前症候群，

asking its female readers,

並這樣問其女性讀者，

"Do you turn into a witch every month?"

「妳每個月都變成巫婆嗎？」

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

有這麼多文章你可能會想， 一定有如山般鐵證

verifying the widespread nature of PMS.

能驗證經前症候群的普遍性。

However, after five decades of research,

然而，經過五十年的研究，

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

眾人對經前症候群的 定義、起因、療法，

the treatment, or even the existence of PMS.

甚至到底是否存在 都沒有強烈共識。

As most commonly defined by psychologists,

心理學家最常用的定義是，

PMS involves negative behavioral, cognitive and physical symptoms

經前症候群會使人 從排卵開始到月經來其間，

from the time of ovulation to menstruation.

陷入負面的行為、 認知、及身體症狀，

But here's where it gets tricky.

但這就是詭異的地方了。

Over 150 different symptoms have been used to diagnose PMS,

已有超過 150 種不同的症狀 被拿來診斷經前症候群，

and here are just a few of those.

這裡只是其中幾種。

Now, I want to be clear here.

那，我要澄清一下。

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

我不是說婦女不會有這些症狀。

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

我要說的是有這些症狀

doesn't amount to a mental disorder,

並不等於妳精神異常，

and when psychologists come up with a disorder

心理學家提出某種失調病症，

that's so vaguely defined,

卻定義模糊不清，

the label eventually becomes meaningless.

這樣的標籤最終會失去意義。

With a list of symptoms this long and wide,

有這麼洋洋灑灑的症狀表，

I could have PMS, you could have PMS,

我可能會得經前症候群， 你可能也會，

the guy in the third row here could have PMS,

第三排的男生也會得經前症候群，

my dog could have PMS. (Laughter)

連我的狗都會得到經前症候群。 （笑聲）

Some researchers said you had to have five symptoms.

有些研究員說你得要有五種症狀，

Some said three.

有些人說三種就好。

Other researchers said that symptoms were only meaningful

還有些研究員說那些症狀

要在非常困擾妳時才有意義。

if they were highly disturbing to you,

but others said minor symptoms were just as important.

但也有人說輕微的症狀也很重要。

For many years, because there was no standardization

多少年了，因為沒有統一

in the definition of PMS,

定義經前症候群，

when psychologists tried to report prevalence rates,

當心理學家試著報出患病率，

their estimates ranged from five percent of women

他們的估計範圍是

5% 到 97% 的婦女有這個病症，

to 97 percent of women,

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

意思是同一時間，幾乎沒有人 或幾乎所有人都有經前症候群。

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

整體來看，經前症候群的 研究方法缺陷相當多。

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

第一，許多研究要求 婦女回溯她們的症狀，

looking to the past and relying on memory,

靠著記憶回想過去，

which is known to inflate reporting of PMS

大家都知道這個方法會大量增加 經前症候群的報告數據，

compared to what's called prospective reporting,

較之於所謂的前瞻性研究，

which involves keeping a daily log of symptoms

要受試者每天記錄症狀

for at least two months in a row.

至少連續兩個月。

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

許多研究也只專注在 白人中產階級婦女，

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

如果將研究結果應用在 全部婦女會成為問題。

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

我們知道相信經前症候群與否 有很強的文化要素，

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

因為這在西方國家以外 幾乎是聞所未聞。

Third, many studies failed to use control groups.

第三，許多研究沒有設控制組。

If we want to understand the specific characteristics

如果我們想要瞭解

有經前症候群婦女的特性，

of women who have PMS,

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

我們必須要將她們與 沒有經前症候群的女性比較。

And finally, many different types of questionnaires were used

最後是，使用太多不同型態的問卷

to diagnose PMS, focusing on different symptoms,

來診斷經前症候群， 專注在不同的症狀，

symptom duration and severity.

症狀持續多久及多嚴重。

To do reliable research on any condition,

要對任何病症做出可靠的研究，

scientists must agree on the specific characteristics

科學家必須先商定

that make up that condition

會造成此病症的特性，

so they're all talking about the same thing,

這樣大家見解才會一致，

and with PMS, this has not been the case.

但是對經前症候群 卻不是這樣研究的。

However, in 1994,

然而，在 1994 年

the Diagnostic and Statistical Manual of Mental Disorders,

精神疾病診斷與統計手冊，

known as the DSM, thankfully --

俗稱 DSM，還好這麼短——

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

這也是身心科專家的手冊——

they redefined PMS as PMDD,

他們重新定義 PMS 成 PMDD，

Premenstrual Dysphoric Disorder.

經前不悅症。

And dysphoria refers to a feeling of agitation or unease.

不悅指的是煩躁不安的感覺。

And according to these new DSM guidelines,

根據這些新的經前不悅症準則，

in most menstrual cycles in the last year,

在過去一年大部分的月經週期中，

at least five of 11 possible symptoms

至少有五種 11 個可能出現的症狀，

must appear in the week before menstruation starts;

在月經來潮前一星期內出現；

the symptoms must improve once menstruation has begun;

這些症狀在月經來潮後就改善；

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

而且這些症狀要在 月經結束一週內消失。

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

一定要有下列四種症狀之一：

marked mood swings, irritability, anxiety, or depression.

顯著的情緒起伏、 易怒、焦慮或憂慮。

The other symptoms could come from the first slide

其他的症狀則可能是 第一張幻燈片

or from those on the second slide,

或第二張幻燈片所列出的，

including symptoms like feeling out of control

包括失控的感覺，

and changes in sleep or appetite.

睡眠或食慾改變。

The DSM also required now that the symptoms

經前不悅症還必須有

should be associated with clinically significant distress --

具臨床意義的明顯困擾——

there should be some kind of disturbance in work

對工作、學校或社交

or school or social relationships --

產生一定程度的影響——

and that symptoms and symptom severity should now be documented

出現的症狀及其嚴重性 必須記錄下來，

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

至少連續兩個週期每天做記錄。

And finally, the DSM required that the emotional disturbance

最後，經前不悅症的情緒困擾，

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

其嚴重性應大於 原有失調的放大效應。

So scientifically speaking, this is an improvement.

所以從科學角度說， 這是很大的進步。

We now have a limited number of symptoms,

我們現在得到有限數量的症狀，

and a high impact on functioning that's required,

要對生活功能產生強烈衝擊，

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

而且對症狀的描述 及發生時間講得很明確。

Well, using this criteria

嗯，使用這個標準

and looking at most recent studies,

並看一下最近的研究，

we see that on average,

我們看到平均

three to eight percent of women suffer from PMDD.

有百分之三到八的女性 為經前不悅症所苦。

Not all women, not most women,

不再說是所有的女性， 多數的女性，

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

也不是大部分的女性， 更不是很多女性：

three to eight percent.

是百分之三到八。

For everyone else, variables like stressful events or happy occasions

對其它女性，變因像是 壓力很大的事件或開心的場合，

or even day of the week

甚至今天是星期幾

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

都比月經更能預測情緒，

and this is the information the scientific community has had

而這是自 1990 年代開始 科學界就有的資料。

since the 1990s.

In 2002, my colleagues and I published an article

2002 年，我與幾個同事 發表了一篇論文

describing the PMS and PMDD research,

講述經前症候群 與經前不悅症的研究，

and several similar articles have appeared in psychology journals.

還有幾篇類似的論文 也發表在心理學期刊上。

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

問題是，為什麼這樣的資訊 還沒有流入大眾？

Why do these myths persist?

為什麼這些迷思依然存在？

Well, certainly the onslaught of messages that women receive

嗯，顯然女性長時間 從書籍、電視、電影及網路

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

接收到的一波波消息， 都說每個人都有經前症候群，

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

已經說服她們這是事實。

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

研究人員告訴我們女性愈相信 每個人都有經前症候群的說法，

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

她就愈有可能錯誤地說她自己有。

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

我解釋一下我說「錯誤」的意思。

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

你可能問她，妳有經前症候群嗎？

and she says yes,

她說有，

but then, when you have her keep a daily log

但之後，在你要她每天記錄

of psychological symptoms for two months,

精神症狀兩個月後，

no correlation is found between her symptoms

她的症狀與月經找不到關連性。

and time of the month.

Another reason for the persistence of the PMS myth

另一個經前症候群迷思 持久不衰的理由

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

與狹隘的女性角色範圍有關。

Feminist psychologists like Joan Chrisler

女性主義心理學家 如喬安克萊斯勒提出，

have suggested that taking on the label of PMS

把自己貼上經前症候群的標籤，

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

讓女性能表達原本會被 視為不嫻淑的情緒。

The near universal definition of a good woman

幾乎放諸四海皆準的好女人定義

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

是快樂、慈愛、對人充滿愛心，

and taking great satisfaction from that role.

並且對這樣的角色很滿足。

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

經前症候群已經成為 能生氣、抱怨、煩躁，

without losing the title of good woman.

卻不會失去好女人頭銜的同意書。

We know that the variables in a woman's environment

我們知道女性的環境中有很多變數

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

比荷爾蒙更容易讓她生氣，

but when she attributes anger to hormones,

但是當她將怒氣歸咎於荷爾蒙，

she's absolved of responsibility or criticism.

她就免於責任，也免除了責難。

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

喔，她平常不是那樣的。 她控制不了。

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

儘管這可以當作有用的工具， 實際上卻否定了女性的情緒。

When people respond to a woman's anger

在大家對女性的怒氣

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

用「喔，大姨媽來了」 這樣的想法來回應時，

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

她被人認真看待 或有效改變的機會就大受限制。

So who else benefits from the myth of PMS?

那麼還有誰會從 經前症候群迷思中得利？

Well, I can tell you that treating PMS

我可以告訴你們治療經前症候群

has become a profitable, thriving industry.

已成為有利可圖、蓬勃發展的行業。

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

亞馬遜網站最近放了超過 1,900 本治療經前症候群的書。

A quick Google search will bring up a cornucopia

在谷歌上隨便找找就能找到

一籮筐的診所、專討或研討會。

of clinics, workshops and seminars.

Reputable Internet sources of medical information

聲譽良好的醫療資源網站

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

如網路醫師或梅奥醫院 將經前症候群列為已知的病症。

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

這並不是已知的病症， 但他們將其列為之一。

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

他們也列出醫師開出的治療藥物，

like anti-depressants or hormones.

如抗憂鬱劑或荷爾蒙。

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

但很有意思的是，兩個網站都說

治療經前症候群的藥物 成效因不同女人而異。

in treating PMS symptoms vary from woman to woman.

Well, that doesn't make sense.

這沒道理。

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

如果你得了某種很明確的病症 起因也很明確，

which PMS is supposed to be,

經前症候群就被歸為此類，

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

那麼應該會在大部分 女性身上看到治療成效。

This has not been the case with these treatments,

但是這些治療藥物並非如此，

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

美國食品藥物管理局的法規說 某種藥物要視為有效，

a large portion of the target population

必須在大部分的目標族群身上

should see clinically significant improvement.

看到有臨床意義的改善。

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

我們還沒有在這些 所謂的治療法上看到這點。

However, the financial gain of perpetuating the myth

然而，延續此項迷思，

that PMS is a common mental disorder

即經前症候群是常見、 可治療的精神病症，

and is treatable is quite substantial.

所得到的經濟利益相當可觀。

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

如果婦女接受藥物 如抗憂鬱劑或荷爾蒙，

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

醫療計畫常規要求她們 必須每三個月回診一次。

That's a lot of doctor visits.

這可是相當大量的就醫次數。

Pharmaceutical companies reap untold profits

製藥公司賺進數不清的利潤，

when women are convinced they should take a prescribed medication

就因為女人接受她們必須

在生育年齡吃處方藥的說法。

for all of their child-bearing lives.

Over-the-counter drugs like Midol

非處方藥物如止經痛藥 「美多」甚至宣稱

even claim to treat PMS symptoms like tension and irritability,

可以治療經前症候群症狀， 如緊張及易怒，

even though they only contain a diuretic, a pain reliever

即使藥物成分只有利尿劑、止痛藥

and caffeine.

及咖啡因。

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

那麼，我沒立場爭論 咖啡因的神奇力量，

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

但我也不認為咖啡因 有減輕緊張的效用。

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

自 2002 年起，美多開始 銷售「婷美多」給青少女。

They are aiming at young girls early,

他們早早把目標對準年輕少女，

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

說服她們每個人都會得經前症候群， 而且這會讓妳變成大怪物，

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

但是等一下！妳還有救的！

Take Midol and you will be a human being again.

吃下美多妳就變回人了！

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

2013 年，美多的銷貨收入 為四千八百萬美金。

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

所以延續經前症候群迷思 除了成為某些人吸金的工具外，

it comes with some serious adverse consequences for women.

還為婦女帶來嚴重的不良後果。

First, it contributes to the medicalization

第一，它使女性的生育健康醫療化。

of women's reproductive health.

The medical field has a long history of conceptualizing

醫界有著很長的歷史 將女性的生育過程

women's reproductive processes as illnesses that require treatment,

視為疾病、需要治療的概念，

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

而這已造成許多花費， 包括過多的剖腹產、

hysterectomies and prescribed hormone treatments

子宮切除術、及開出荷爾蒙治療藥，

that have harmed rather than enhanced women's health.

而藥物的傷害大於增進婦女健康。

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

第二，經前症候群迷思也是造成女性

as irrational and overemotional.

易怒及過度情緒化的刻板印象原因。

When the menstrual cycle is described as a hormonal roller coaster

一旦月經週期被形容為 荷爾蒙雲霄飛車，

that turns women into angry beasts,

把女性變成氣呼呼的野獸，

it becomes easy to question the competence of all women.

我們就很容易質疑女性的能力。

Women have made tremendous strides in the workforce,

婦女在工作場合的地位 已有極大的進步，

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

但是仍然只有極少數的女性

處在政府或企業的高層職位，

of fields like government or business,

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

而且每次我們考慮什麼樣的人 可稱為好的執行長或參議員，

someone who has qualities like rationality, steadiness, competence

具有理性、穩健、能力等條件的人

come to mind,

就會在腦中浮現，

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

在我們的文化，那些條件 聽起來更符合男人而非女人，

and the PMS myth contributes to that.

經前症候群迷思正是助長的原因。

Psychologists know that the moods of men and women

心理學家知道男人與女人的情緒

are more similar than different.

更趨相似而非相異。

One study followed men and women for four to six months

一項研究追蹤男人與女人 四到六個月，

and found that the number of mood swings they experienced

發現兩性經歷心情起伏的次數

and the severity of those mood swings were no different.

及其嚴重性並沒有不同。

And finally, the PMS myth keeps women from dealing

最後，經前症候群迷思 不讓女性處理

with the actual issues causing them emotional upset.

造成他們心煩意亂的真正原因：

Individual issues like quality of relationship or work conditions

個人因素如 人際關係品質或工作環境，

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

或社會因素如種族歧視、 性別歧視或貧窮的磨難，

are all strongly related to daily mood.

都與每天的情緒有很大的關係。

Sweeping emotions under the rug of PMS

以經前症候群當藉口 逃避情緒問題，

keeps women from understanding the source of their negative emotions,

只是讓女人更難瞭解 她們負面情緒的來源，

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

同時也拿走讓她們 以行動來改變情緒的機會。

So the good news about PMS

所以經前症候群的好消息

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

是有些女人的確因 月經週期而有某些症狀，

the great majority don't get a mental disorder.

但大部分的女人並不 因此而得了神經病。

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

她們照常工作、上學、照顧家庭，

and function at a normal level.

以正常的水準行使職責。

We know the emotions and moods of men and women

我們知道男人與女人的情緒及心情

are more similar than different,

更趨相似而非相異，

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

所以讓我們從陳腐的 經前症候群迷思中走出，

不再視女性為巫婆， 而能接受絕大部分女性

and embrace the reality of high emotional and professional functioning

每天都過著高情緒 及高專業功能生活的事實。

the great majority of women live every day.

Thank you.

謝謝。

(Applause)

（掌聲）