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Periodic Bitch
By Emma Hardy
Allen & Unwin
Reviewed by Cushla McKinney
Premenstrual dysphoric disorder (PMDD) is a severe form of pre-menstrual syndrome whose physical and psychological symptoms are so distressing that up to 15% of those with the condition attempt suicide.
Although estimated to effect about 5% of people who menstruate, it often takes years for people to receive an accurate diagnosis, and even longer to find effective treatment.
Reasons for this include lack of research into the condition’s aetiology and the fact that what works for some is completely ineffective for others.
It is also an illness that is freighted with cultural and historical baggage, and the reluctance of clinicians to provide a diagnosis also reflects justifiable concerns about (re)pathologising female biology.
It has taken decades of activism to destigmitise pre-menstrual syndrome, and the inclusion of PMDD in the DSM-V was controversial.
But, as Australian essayist and author Emma Hardy’s memoir reveals, failure to provide adequate support and treatment for those who need it can destroy careers, relationships and lives.
Despite regularly cycling between identities (a happy, capable well-self, and an ill-self so emotionally labile and angry that she wants to claw herself out of her own skin), Hardy eschewed treatment for years because the latter disappeared like a bad dream at the onset of her period.
Things came to a head during Covid, when the stress and isolation intensified her symptoms to the point they became so severe she considered everything from surgically induced menopause to suicide to escape them.
Although she eventually found a pharmacological solution, it was a far from straightforward process.
A medication many sufferers described as a miraculous successfully stabilised her mood but left her catatonically depressed, and it ultimately took a combination of hormonal and neurochemical modulation to restore her to herself.
Although hoping her memoir will encourage others to seek help, Hardy’s primary goal is to contribute to a growing discourse on the ways women’s pain has been pathologised or ignored, and ways in which illness is influenced by a convergence of physical, psychological and cultural factors.
Her underlying thesis is that PMDD is stigmatised because it embodies everything that has been deemed unacceptable in women and that these expectations and associations can drive people’s experience of illness as much as biology.
Her discussion covers everything from cultural portrayals of ‘monstrous’ women such as Medusa and Carrie to the use of PMDD as a legal defence at trial: What, she asks, differentiates justifiable rage from menstrual illness?
Can their violence be attributed to psychosis, or is it that the condition reduced their tolerance to the point where they could no longer cope with an abusive environment?
Periodic Bitch is a thoughtful and nuanced exploration of a complex condition, and Hardy is refreshingly honest about her ambivalent feelings about the benefits and disadvantages of her own diagnosis.
It would be nice to think that as a society we are ready to listen to stories like Hardy’s and move beyond reductive interpretations of gendered illness.
Whether this is actually the case remains a moot point.
Cushla McKinney is a Dunedin scientist