After Joan Didion's "In Bed" [link]
(With Apologies to Joan Didion)
Three, four, sometimes seven days a month, I spend my life in a PMS haze, hyper-sensitive to the world around me. Almost every day of every month, between these attacks, I feel the sudden irritation and the flush of black mood and brain fog, which remind me that PMS lies in wait for me, and I take certain drugs to prolong its arrival. If I did not take the drugs, I would be able to function normally perhaps one week in four. The physiological horror called PMS is, in brief, central to the given of my life. When I was 15, 16, even 25, I used to think that I could rid myself of this error by simply denying it, character over chemistry. “Do you suffer PMS sometimes? frequently? never?” no application form asked, ever, though certain doctors would inquire. “Tell me about it.” Wary of going down this road again, but wanting only to somehow make the case that I wasn’t simply balls out crazy, I would elaborate. “It’s killing me,” I would say. “It’s like during that time period, the regular me, the me that knows how to get through life, sometimes even skillfully, ceases to exist.” “Hmmm,” they’ll say, marking something down on a chart and maybe suggesting vitamins. That in fact I spent one week a month in an impossible mental state seemed a shameful secret, evidence not merely of some chemical inferiority but of all my bad attitudes, unpleasant tempers, wrongthink.
For I had no brain tumor, no eyestrain, no high blood pressure, nothing “wrong” with me at all: I simply had severe PMS, or PMDD, and severe PMS was, as everyone who does not have it knows, imaginary. I fought PMS then, ignored the warnings it sent, went to school and later to work in spite of it, sat through lectures in American History and presentations to clients with alternating thoughts of panic, sadness and the deepest fury, cried inconsolably in washrooms, stumbled home by instinct, emptied bottles of wine into huge glasses trying to halt the maelstrom in my mind, wished only for an internist who would do a hysterectomy on house call, and cursed my anatomy.
It was a long time before I began thinking mechanistically enough to accept PMS for what it was: something with which I would be living, the way some people live with diabetes. PMS is something more than the fancy of a neurotic imagination. It is an essentially hereditary complex of systems, the most frequently noted but by no means the most unpleasant of which is an uncontrollable tetchiness, suffered by God knows how many women, by no men at all (the motherfuckers), and by some unfortunate girls as young as nine years old. (I had my first when I was thirteen. It came on during study hall at Peachtree Junior High in Dunwoody, Georgia. I told no one but instead sat quietly and began assembling a catalog of punishing ruminations that I would return to for the duration of my life. No one prescribed anything.) Almost anything can exacerbate my monthly attack of PMS: stress, allergy, a cold, an unfair deadline, a bad meal. An errant remark. A wrong turn. One inherits, of course, only the predisposition. In other words I spent yesterday incapable of getting a single drop of work done not merely because of my bad attitudes, unpleasant tempers and wrong-think, but because both my grandmothers had PMS, my mother has PMS and my sisters have PMS.
No one knows precisely what it is that is inherited. The chemistry of PMS, however, seems to have some connection with the naturally occurring neurotransmitter serotonin, which is believed to be a contributor to feelings of well-being and happiness. The amount of serotonin in the blood falls sharply at the onset of PMS, and one PMS drug, fluoxetine, or Prozac (sometimes marketed in a pink package as “Sarafem”), seems to have some effect on serotonin. Fluoxetine is what they call a “selective serotonin reuptake inhibitor,” and it delays the brain’s reabsorption of the chemical. Side effects include anorexia, impotence, anxiety, insomnia, abnormal dreams, dry mouth, dyspepsia, diarrhea, nausea, nervousness and many more, yet it is prescribed constantly, for all types of ailments, because no one is actually sure of how it works or what it even does. Fluoxetine, when it is prescribed, is taken daily, as a preventative; another preventative which works for some people is old-fashioned exercise and a “balanced” diet, whatever that means.
Once an attack is underway, however, no drug touches it. PMS gives some people mild depression, temporarily incapacitates others, shows up not only as irritability but as a gastrointestinal disturbance, a painful sensitivity to all sensory stimuli, an abrupt overpowering fatigue, absentmindedness, and a crippling inability to make even the most routine decisions. When I am in the heart of PMS (for some people this lasts a day, for others several), I will drive through red lights, forget my passwords, spill whatever I am holding, lose the ability to crack jokes or write coherent sentences, and generally give the appearance of being out to lunch. PMS is, of course, a prelude to menstruation, which, when it comes, brings with it bleeding, cramps, bloat, exhaustion and a lassitude that seems to stretch the very limits of endurance. That no one dies of the whole business seems, to someone deep into an attack, an ambiguous blessing.
I do not have a husband but if I did he would not suffer from PMS, which is fortunate for him but unfortunate for me: perhaps nothing so tends to prolong an attack as the accusing eye of someone who has never experienced a full menstrual cycle. “Why not take a couple of ibuprofen,” the unafflicted offer, unbidden, or “I’d feel despondent, too, stewing over every imagined slight that comes my way.” All of us who have PMS suffer not only from the attacks themselves but from this common conviction that we are perversely refusing to cure ourselves by taking the mental high road, that we are making ourselves miserable, that we “bring it on ourselves.” And in the most immediate sense, the sense of why we have PMS this week and not last week, that is, of course, absurd. If there is a “PMS personality,” no one has ever told me about it to my face, but lifelong observation would suggest that that personality tends to be bitchy, unreasonable, unpredictable, whiny, weepy and prone to blowing things way out of proportion. (One might just call this the “female” personality.) “You’re different from most women,” a man once said to me. “So rational. Like you don’t freak out about things that don’t really matter.” Actually my emotional response to any given situation far outweighs whatever logic I’ve applied to it, but the man was right nonetheless: I have learned to bury my propensity to flip out under a blanket of stoicism that allows me to function in the everyday world. PMS stretches that blanket very, very thin.
But not all females have severe PMS, and not all sufferers of severe PMS have “female” personalities. We do not escape heredity. I have tried in most of the available ways to escape my own premenstrual heredity (on multiple occasions I eliminated all potential dietary triggers, including caffeine, sugar, dairy, alcohol and grains, even though the diet itself made my social life so miserable I had to cease it entirely), but I still have PMS. And I have learned now to live with it, learned when to expect it, how to deal with it, even how to regard it, when it does come, as an opportunity to test my survival skills. We have reached a certain understanding, my PMS and I. It comes like clockwork. Tell me that I’ve been fired, my dog has run off, that there is gun fighting in the streets and panic in the banks, and I will grit my teeth and add this grief like a new log on an already roaring fire. It comes, too, when I am fighting not an open but a guerilla war with my own life, during weeks of small work-related aggravations, unanswered emails, looming invoices, canceled dates, on days when I slog through cardio and I fail to call my mother and the wind is coming up. On days like that it laughs as if to say, “Oh, you think your life is relatively under control, do you?”
And once it comes, now that I am wise in its ways, I no longer fight it. I don’t have the luxury of lying around and waiting for it to pass, so I go on with life. Every small apprehension is magnified, every anxiety a pounding terror. Then the blood comes, and I know that means the ordeal is nearly over. Right there is the usefulness of PMS, there in that forced suffering, the monthly confrontation with mortality. For when it recedes, five to seven days later, everything goes with it, all the hidden resentments, all the pointless anxieties. The PMS has acted as a circuit breaker, and the fuses have emerged intact. There is an immense euphoric relief. I leave the office on time and feel the air, eat gratefully, sleep well. I notice the singular joy of feeling like my life is fine just as it is. I count my blessings.
There were a couple of years during my early 30s where I read the essays in Joan Didion's Slouching Toward Bethlehem and The White Album over and over. I am far from the first person to say so, but she captured something visceral about the experience of being a young(ish), struggling woman in Southern California that still rang true nearly 50 years later. "In Bed" was a favorite because Didion's experience of migraines so closely matched up with my experience of PMS—a phenomenon that many (if not most) people do not think is real but that has a tremendous impact on my existence nonetheless. Years later, the science has not advanced all that much, as far as I can tell; there's still a lot we don't understand about both ailments. And while you might find more people who are sympathetic to their sufferers, they still seem to fall into the category of dubious claims made by suspect people. Covering this essay is my attempt to own it. Maybe I am a headcase—what of it?
Sara Campbell writes Tiny Revolutions, an email newsletter about becoming who you are. Rooted in her practice of Zen Buddhism, it’s a personal exploration of how to be more awake, alive, and connected to the truth of your life—and to the world around you. Her writing has appeared in diverse outlets including Every, The RS 500, Barrelhouse, The Oxford American, The Hairpin, The Rumpus, and Salon.com. She lives in Los Angeles but does various things on the Internet to pay the bills. You can find her clowning around on Twitter @janedonuts.