strange case of Dr. Jekyll and Ms. Hyde: How PMS become a cultural phenomenon and a psychiatric disorder, The

Industrialization may contribute to the belief in modern societies that one can and should exercise self-control in order to feel and to behave the same way every day (Martin, 1988). American culture encourages people to believe that they have more control over their lives and their bodies than is actually possible (Brownell, 1991; McDaniel, 1988). Landers (1988) has suggested that PMS is a metaphor for the common inability of women to control their life situations. Premenstrual women often complain of feeling "out of control" because they are angry, irritable, exhausted, craving sweets, or unwilling, even temporarily, to put others' needs ahead of their own. Control is so important to some American women that even the thought of being out of control is frightening (Ritenbaugh, 1982). This impossible-to-satisfy need for control contributes to self-diagnosis of PMS and PMDD and to other behavior patterns that are related to depression (e.g., perfectionism, eating disorders, compulsive exercise). Furthermore, because of the preference in industrialized societies for control, order, and stability (i.e., people should behave like well oiled machines), characteristics such as changeableness, rhythmicity, and emotionality have come to be seen as inherently unhealthy (Koeske, 1983).

Most of the research on PMS and PMDD has been done by scientists in a few Western countries (Australia, Canada, Germany, Great Britain, the Netherlands, Sweden, and the U.S.), which share many common cultural beliefs (Chrisler, 1996). The vast majority of participants in studies of PMS and PMDD are European American, middle class, college students or married women. Participants are most often recruited from psychology classes or from private psychiatric or obstetric/gynecologic practices or university hospitals to which lower income women may not have access. This methodological limitation is rarely mentioned in review articles, but it may be important in understanding whose (and how) experience has been medicalized (Chrisler & Johnston-Robledo, 2002). World Health Organization surveys indicate that menstrual cycle-related complaints (except cramps) are most likely to be reported by women who live in Western Europe, Australia, and North America. Data collected from women in Hong Kong (Chang et al., 1995) and mainland China (Yu, Zhu, Li, Oakley, & Reame, 1996) indicate that the most commonly reported premenstrual symptoms are fatigue, water retention, pain, and increased sensitivity to cold. American women do not report cold sensitivity, and Chinese women rarely report negative affect. The results of these studies thus support the idea that culture shapes which variations in mood and physical sensations are noticed and which are of concern. Further support comes from Paige's (1973) survey of women in the U.S. She found that the most severe menstrual complaints came from strict Catholics and Orthodox Jews, both of whom strongly adhered to the traditional feminine gender role.

Popular culture plays an important role in establishing and maintaining beliefs, such as that all women behave irrationally or are overly emotional just before their menstrual periods. The images that support beliefs about premenstrual women are ubiquitous in magazines, films, television shows, greeting cards, calendars, songs, self-help books, comic strips, advertising, and other media. They are easily absorbed into a kind of folk wisdom-things "everyone knows" about women (Chrisler & Johnston-Robledo, 2002). Such knowledge leads to self-diagnosis with PMS or PMDD and, ultimately, to the perpetuation of stereotypes about women through attributions about self and others.