' T H A T T I M E OF T H E M O N T H " : T H E H I S T O R Y O F P M S R E S E A R C H I N V A N C O U V E R 1983-1997 by A L L I S O N S A N D R A C L A R K B . A . , The University of N e w Brunswick, 1997 A T H E S I S S U B M I T T E D I N P A R T I A L F U L F I L M E N T O F T H E R E Q U I R E M E N T S F O R T H E D E G R E E O F M A S T E R O F A R T S in T H E F A C U L T Y OF G R A D U A T E S T U D I E S (Department o f History) We accept this thesis as conforming to the-required standard T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A January 2000 V © Allison Sandra Clark, 2000 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. 1 further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of M i S T o g ^ j The University of British Columbia Vancouver, Canada Date J " A N > LA-Aa.*.j IL loco DE-6 (2/88) 11 Abstract This thesis examines how the women's movement of the 1960s and 1970s influenced scholarship in the social sciences, and how the feminism growing out o f this movement affected premenstrual syndrome (PMS) research. Since the 1980s social science paradigms guiding P M S research have begun to consider how biology and the environment mutually influence one another to produce premenstrual changes. The work examined in this thesis uses feminism to challenge traditional scientific approaches to P M S , including claims of "objectivity," negative evaluations o f menstrual changes in women, the claim that women experience natural cycles and men do not, and the belief that the expression of anger contradicts the feminine role. The research herein is based on all psychology research on P M S produced in the greater Vancouver area during the 1980s and 1990s. The knowledge that has been constructed about P M S through social sciences research also contributes to a common narrative about gender. This narrative holds that femininity and masculinity are not only linked to concepts o f biological sex but also to concepts of culture that are heavily influenced by power relationships. The research examined here contributes to this narrative by challenging traditional theories about women's nature and by implementing research methods that add to our understanding of the way that cultural values influence research and knowledge production. The image of women as passive victims o f "that time of the month" has been called into question by an image o f women that takes society and culture into account when explaining "women's nature." Table of Contents Abstract Acknowledgments Introduction Literature Review Vancouver Research Projects on P M S Conclusion and Directions for Future Study. Bibliography iv Acknowledgments I would like to thank everyone at the University o f British Columbia history department, including my supervisor Dianne Newell; other professors I studied with (David Breen, Mark Phillips); professors I assisted with teaching (Steve Straker, Peter Ward); Joy Dixon for her role as second reader for this thesis; Gloria Lees, our graduate secretary; and Bob McDonald our graduate advisor, whose active involvement in student activities, especially the Qualicum Conference, is greatly appreciated. In my personal life, I would like to thank my dad for his invaluable pep talks; my mom for her strength and friendship; my grandmother for being a wonderful role model and supporting my education; and Aunt Jean, Aunt Jude, Les and Jon, for giving me a sense of family wherever I am. I would also like to thank Claire for her humour and empathy and the Scales for always welcoming me into their home. Lastly but most importantly, I would like to thank Brian. His love and friendship has been offered without condition, a gift for which there are no words. I wil l always remember the support he has provided. 1 Introduction In 1931, the American psychologist, R .T . Frank suggested the term premenstrual tension (PMT) to describe a constellation of unpleasant symptoms that were reported by some U . S . women the week before menstruation.1 These symptoms included bloating, headache, weakness and irritability, as well as other physiological and psychological changes. In 1964 the term premenstrual syndrome (PMS) was introduced by British physician, Katharina Dalton, to describe the same condition that Frank described as premenstrual tension.2 B y exchanging the word "tension" for the word "syndrome," Dalton meant to suggest that premenstrual symptoms constitute a disease, with their cause rooted in physiology. Dr . Dalton's physiological explanation for P M S set the trend in P M S research for over thirty years, and largely contributed to the designation of premenstrual syndrome as a disease within the biomedical model. 3 Since Dalton first proposed the term P M S , a considerable debate has ensued over its definition. The terms P M S and P M T continue to be confused and used interchangeably and a precise definition for premenstrual changes has not yet been reached. The terms P M S and P M T continue to dominate common usage, but new terms have been suggested in recent years. For example, the ^ . T . Frank, "Hormonal Causes of Premenstrual Tension," Archives ofNeurology and Psychiatry 26 (1931): 1053. katharina Dalton, The Premenstrual Syndrome (London: William Heineman Medical Books Ltd. , 1964), 1. 3 The biomedical model referred to in this paper is an explanatory framework that describes the behaviour o f individuals and characteristics of societies in terms of biology. This model defines nature as physical and materialistic, and promotes the idea that there is a single, underlying, universalizable truth. See Ruth Hubbard, The Politics of Women's Biology (New Brunswick: Rutgers University Press, 1990), 107-118, and Arthur Kleinman, "What is Specific to Western Medicine?" in Companion Encyclopedia of the History of Medicine, vol. 2, eds. W.F . Bynum, and Roy Porter (New York: Routledge, 1993), 15-23. 2 American Psychiatric Association suggested the terms Late Luteal Phase Dysphoric Disorder ( L L P D D ) in 1987 and Premenstrual Phase Dysphoric Disorder ( P M D D ) in 1994. While there is no universally agreed upon definition for premenstrual changes, each of the named terms serves roughly to explain the same phenomenon. This phenomenon, which I will call P M S throughout this thesis for the sake of consistency,4 has been the source of great debate since Dalton's biomedical explanation for P M S first came under attack in the 1970s. Challenges to Dalton's explanation for P M S first developed in conjunction with the women's movement of the 1970s, when several pioneers in the field of feminist psychology began to provide empirical evidence that contradicted the traditional theories o f biomedicine. Mary Brown Parlee, Barbara Sommer, and Randi Koeske 5 uncovered a number of assumptions in P M S research that can best be characterized as masculinist, or as upholding "an ideological perspective in which gender differences are depicted as binary oppositions, negatively weighted in favour of males and used to justify male domination over women." 6 Their attempt to challenge masculinist assumptions in biomedical models o f P M S , and the introduction of methods that consider the influence o f social variables in producing P M S , mark the beginning o f feminist influenced P M S research. 4 P M S is currently the most common term used in North America and it is the term used by the researchers examined in this thesis. I will also use the term P M S , unless I am citing someone who uses an alternate term. 5 M . B . Parlee, "The Premenstrual Syndrome," Psychological Bulletin 80:6 (1973): 454-465; M B . Parlee, "Stereotypic Beliefs About Menstruation: A Methodological Note on the Moos Menstrual Distress Questionnaire and Some N e w Data," Psychosomatic Medicine 36:3 (1974): 229-240; B . Sommer, "Stress and Menstrual Distress," Journal of Human Stress 4:3 (1978): 5-10; B . Sommer, "Menstrual Cycle Changes and Intellectual Performance," Psychosomatic Medicine 34:3 (1972): 263-269; Randi Koeske, "Premenstrual Emotionality: Is Biology Destiny?" Women and health 1 (1976): 11-14. 6Jacquelyn N . Zita, "The Premenstrual Syndrome: 'Dis-easing' the Female Cycle," in Feminism and Science, ed. Nancy Tuana (Bloomington: Indiana University Press, 1989), 190. 3 Psychology students in the. Greater Vancouver area conducting P M S research since the early 1980s have adopted aspects o f feminism in their work. Their work generally challenges the masculinist voice of "objectivity," the depiction of negatively evaluated changes in women, the claim that women experience natural cycles whereas men do not, and the belief that the expression of anger by women contradicts the feminine role. The research projects examined include those that explore the connection between intellectual ability and menstruation, those that explore the accuracy and usefulness of the P M S definition, and those that explore the role of stereotypes in the application of the P M S label. The introduction of feminist approaches to P M S in the literature has uncovered the extent to which our knowledge about P M S is constructed by a historically situated explanatory framework. Until the 1970s, no conceptual framework was in place to challenge biomedical models o f P M S , but with the women's movement and developments in feminist theory, frameworks were created to propose an alternative explanation for P M S , showing that there is no single, universal possibility. Feminist interpretations, however, have often been overlooked by mainstream reporting on P M S research. On January 23, 1998 the Toronto Globe and Mail carried an article that cites new reported research, the essence o f which is captured by the headline ' T M S cause is biological not emotional."7 This headline attributes the cause o f P M S to biology, implying that P M S is in women's nature and unchangeable except through physiological interventions, for example hormone therapy, as the research under investigation in this article suggests. Currently, there is still no known cause for P M S , although, as one medical specialist has observed, "at least 50 treatment options have been 7Jane Brody, " P M S Cause is Biological, not Emotional Study Says," The Toronto Globe and Mail 28 January 1998, sec. A l , 1. 4 suggested to be effective, many of them based on the popular hypothesis o f the moment."8 One-sided reporting has dominated the popular press, but has also characterized much o f the scholarly literature on P M S . Numerous contradictions in the P M S literature has caused researchers, like those later examined in this case study, to argue that the biomedical model has failed to provide an understanding of the cause(s) and effective treatment solutions for P M S . This has led increasingly to the consideration o f possible psychological, societal, and cultural factors in P M S . 9 P M S first gained considerable public attention in the early 1980s with two court cases in Britain in which the defendants, Christine English and Sandie Smith, were tried for separate violent crimes. Both were acquitted on the basis of P M S . Dr. Katharina Dalton, still the leading P M S expert at the time, testified that each woman was at the mercy of her monthly menstrual cycle and corresponding hormones. 1 0 In Bernadette McSherry's 1992 article, "The Return of the Raging Hormones Theory," Dalton is credited with the "depiction o f premenstrual syndrome as a 'disease' or 'illness' which could be treated."1 1 McSherry argues that reducing P M S to the "effects o f raging hormones" takes too simplistic an approach, and that there is no firm evidence to show that "raging hormones cause conditions such as premenstrual syndrome...nor that such conditions lead to female 8 Meir Steiner, Susanne Steinberg, Donna Stewart, Diana Carter, Charlene Berger, Robert Reid, Douglas Grover, and David Streiner, "Fluoxetine in the Treatment o f Premenstrual Dysphoria," The New England Journal ofMedicine 332:23 (1995): 1529. 9Jessica Ann McFarlane, and Tannis MacBeth Williams, "The Enigma of Premenstrual Syndrome," Canadian Psychology 31:2 (1990): 95. 1 0Valerie Hey, "Getting Away with Murder: P M T and the Press," in Seeing Red: The Politics of Premenstrual Tension, eds. Sophie Laws, Valerie Hey, and Andrea Eagan (London: Hutchinson, 1985), 69. "Bernadette McSherry, "The Return o f the Raging Hormones Theory: Premenstrual Syndrome, Postpartum Disorders, and Criminal Responsibility," Sydney Law Review 15:292 (1992): 296. 5 crime." 1 2 Dalton's biological view o f P M S , however, was accepted by the courts in 1981 and further institutionalized in 1987 when it was included in the appendix o f the American Psychiatric Association's revised third edition o f the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)13 Feminist groups, women's health organizations, and the medical community again debated the social consequences of defining P M S as a disease and, in particular, as a mental disorder. Those who favoured the inclusion of P M S in the Diagnostic and Statistical Manual argued that it would legitimate the claims o f women who suffered from premenstrual changes every month. Feminist groups, on the other hand, opposed the inclusion of P M S in the Diagnostic and Statistical Manual arguing that it would provide biological justifications for stereotypes o f women when no known cause for P M S had yet been discovered. These debates in 1987, along with the trials in Britain in 1981, fueled a re-examination o f P M S and suggested that it contains meaning beyond the purely scientific meaning suggested by biomedicine. In the backlash that followed these events, the most outspoken critics o f biomedical views were the growing number o f women who identified themselves as feminists, some of whom were academics determined to re-shape the existing body of knowledge about P M S . The results o f their work has been available since the mid-1980s, much of it growing out of research at post-secondary institutions. Universities continue to play a critical role in shaping intellectual trends and developing 1 2 McSherry, "The Return of the Raging Hormones Theory," 316. "American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3d ed. rev. (Washington, D . C : American Psychiatric Association, 1987), 367-369. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual produced by the American Psychiatric Association and used throughout the United States and Canada to classify and diagnose various mental disorders. The 1980 publication is referred to as the DSM-III, the 1987 publication as the DSM-III-R, and the 1994 publication as the DSM-W. 6 new theories that subsequently become a measure of contemporary ideas on an existing subject. The role of university social scientists in the development o f knowledge about P M S has been to provide competing intellectual frameworks to those developed in other professional fields. Since the 1980s, researchers, primarily in the humanities and social sciences like those examined in this thesis, have revived and tested the view that human behaviour is not a fact o f nature but constructed by the social circumstances in which people live. This thesis argues that feminist theories and methods have had a great impact on P M S research since 1980. It looks at psychological research conducted in Greater Vancouver, British Columbia, focusing on graduate and undergraduate research produced at Simon Fraser University (SFU) and the University of British Columbia (UBC) . I argue that the rise of feminist theories and methods since the 1970s has changed the way that P M S is understood, This paper is a case study o f the entire output of psychology research on P M S in the Greater Vancouver area, between 1983 and 1997. From the Dissertation Abstracts database I was able to retrieve 14 dissertation titles relating to P M S in Canada. Dissertation Abstracts includes only Ph.D. dissertations, so the Masters theses and one Bachelor honours essay I retrieved were located through U B C and SFU' s library databases. O f the dissertations located, just over 70% were produced between 1987 and 1992, a few years after P M S had gained most of its notoriety through the trials in Britain. The first dissertations appeared in 1981-1982 in Ontario to suggest that some research was being conducted in Canada prior to the trials. O f the six dissertations produced after 1990 four were produced at Universities in British 7 Columbia, all from within the discipline of psychology. 1 4 This suggests, perhaps, that B C ' s universities and, more specifically, their psychology departments, offered a special opportunity to conduct research in this area. While the field o f psychology is not the only field conducting research on P M S in Greater Vancouver, it is the most productive field o f research on P M S and the one that most reflects the influences of feminism. Psychology has also generated the most diverse body o f work my research uncovered. Six students completed major research projects on P M S including one honours graduating essay, five Masters theses and three Ph.D. dissertations in psychology, as well as several publications that grew out o f the work o f one U B C student and her supervisor. B y comparison, I found only two Vancouver psychiatrists and one endocrinologist who conducted research on P M S . 1 5 1 4 A n overwhelming number of the dissertations produced are primarily affiliated with psychology departments. Secondary affiliations with women's studies departments are common and on occasion the primary affiliation is with education, or sociology. 1 5Psychiatrists, Diana Carter and Shaila Misr i , opened British Columbia's first P M S clinic at Vancouver's Shaughnessy Hospital in 1986. The facility changed its name to the Women and Children's Hospital o f British Columbia in 1990, but the P M S clinic has remained under the direction of the named physicians. Carter and Misr i began to conduct research on the patients that visited their clinic in 1986, but no archival material (publications, annual reports, pamphlets) was kept until 1990. The first available measure o f research conducted at the clinic is the publication of an article in 1995 in The New England Journal of Medicine, reporting the results of a Canada-wide fluoxetine study [Meir Steiner et al., "Fluoxetine in the Treatment of Premenstrual Dysphoria," 1529-1534]. Fluoxetine is a pharmaceutical drug known as a serotonin re-uptake inhibitor. It facilitates the production of serotonin, a compound in blood serum that acts like a neurotransmitter in the brain. Fluoxetine is used to treat symptoms of depression by some physicians, including Carter and Misr i . Vancouver endocrinologist Jerrilyn Prior has also conducted research on P M S . Two articles that represent her work in the area are: J. C. Prior, "Conditioning Exercise and Premenstrual Symptoms," Journal of Reproductive Medicine 32 (1987): 423-428, and J.C. Prior, "Cyclic Medroxyprogesterone Treatment Increases Bone Density: A Controlled Trial in Active Women with Menstrual Cycle Disturbances," American Journal of Medicine 96.6 (1994): 521-530. What is significant about Dr. Prior's work is her effort to accommodate both feminist and scientific goals. She received a Bachelor of Arts before completing her medical degree and becoming a Professor o f Medicine in Endocrinology at the University of British Columbia. Dr . 8 Although P M S research has also been conducted Canada-wide in the fields o f nursing, family science, kinesiology and education, I have discovered no examples of Vancouver-based studies in these fields. Greater Vancouver is a strong center for P M S research because it has several large hospitals, including British Columbia's only Women and Children's Hospital, and also two universities that operate as sites for major research projects in a number of fields. The University o f British Columbia is a school of over 35,000 students16 and has some o f Canada's leading research facilities. Also, the university has fostered an interest in Women's Studies since 1991, the first year that U B C students could major in Women's Studies. The Women's Studies programme at U B C encourages interdisciplinary research and as a result there are scholars across many fields working from a feminist perspective.17 While S F U has approximately 18,000 students18 and no medical school, their program in Women's Studies predates U B C ' s . A Bachelor of Arts program was established in 1975, and a Master of Arts program was established in 1985, 1 9 indicating early and continuing support for Women's Studies education at S F U . While no single academic researcher dominated the research at S F U , the feminist psychologist, Dr . Tannis MacBeth Williams, guided the research of both of U B C ' s graduate Prior is rare in her interest and ability to critique science from within the field. She is among a new generation of feminist scientists who have used their knowledge o f feminism to change their approach to science and medicine. She moves away from the biomedical model used by Carter and Misr i and toward a model that provides room for emotional and social context. 1 6University of British Columbia. 1999. "Public Affairs," Available [Online]: [15 December 1999]. "University of British Columbia. 1999. "Women's Studies and Gender Relations Mandate," Available [Online]: [15 December 1999]. 1 8 Simon Fraser University. 1999. "About S F U , " Available [Online]: [15 December 1999]. 1 9 Simon Fraser University. 1999. "General Information on Women's Studies," Available [Online]: [15 December 1999]. 9 researchers on P M S , Jessica McFarlane and Shelley Moore. Williams involvement with these students spans over fourteen years, almost the entire period under study in this thesis. Williams co-authofed three articles with McFarlane, " M o o d Fluctuations: Women Versus M e n and Menstrual Versus Other Cycles" (1988), "The Enigma o f Premenstrual Syndrome" (1990), and "Placing Premenstrual Syndrome in Context" (1994), 2 0 indicating the proliferation o f their work in the field of psychology. Also, McFarlane and Moore were assisted financially in their studies as employees of Williams, who won a Social Sciences and Humanities Research Council (SSHRC) fellowship for a long-term study of P M S . This suggests that their research was considered sufficiently important to warrant funding from a national granting agency. McFarlane and Moore tested different hypotheses in their research, but their projects were part of the same, larger collaborative enterprise between Williams and themselves. Shelley Moore is a sessional instructor in the Women's Studies programme at U B C , and Jessica McFarlane is a counselor for women, children and families in Vancouver. O f the researchers who completed work on P M S at S F U , Judith Youdale, the only Ph.D. recipient and most likely candidate to have publications has not published in scholarly journals. A s far as I have uncovered, no other S F U researchers have scholarly publications, nor have they continued to have a professional interest in P M S . I have been unable to locate information about Masters student, Delores Escudero, but each of Cheryl Fraser and Holly Prochnau went on to complete Ph.D. degrees in other areas o f psychology at S F U . 2 0Jessica McFarlane, Carol Lynn Martin, and Tannis MacBeth Williams, " M o o d Fluctuations: Women Versus Men and Menstrual Versus Other Cycles," Psychology of Women Quarterly 12:2 (1988): 201-223; Jessica Ann McFarlane, and Tannis MacBeth Williams, "The Enigma of Premenstrual Syndrome," 95-108; Jessica Motherwell McFarlane, and Tannis MacBeth Williams, "Placing Premenstrual Syndrome in Perspective," Psychology of Women Quarterly 18:3 (1994): 339-373. 10 Literature Review Early challenges to the traditional view that science is value-free were developed in the philosophy o f science by such pioneers as Thomas S. Kuhn. His seminal work, The Structure of Scientific Revolutions, first appeared in 1962 and argued that scientific theories are replaced through a subjective process whereby specific scientific communities consensually agree to accept a new theory in place o f an old one. This transformation, according to Kuhn, has more to do with generational ties, individual loyalties, and personal beliefs2 1 than it does with scientific facts. Kuhn suggested that science is no less historical than any other discipline and is therefore susceptible to the context in which it is produced. Kuhn's ideas about scientific paradigms influenced a branch of sociology and the general field of science studies that emerged in the 1970s. Two leaders in science studies, Bruno Latour and Steven Shapin,2 2 have argued that science is socially constructed 2 3 and that scientists, scholars, and the public need to consider the role that beliefs and values play in the construction o f knowledge and the practice of science. Feminist studies o f science since the 1970s and 1980s have also concentrated on the mechanisms used by science to socially construct knowledge, but more specifically they have 2 1Thomas S. Kuhn, The Structure of Scientific Revolutions (Chicago: The University o f Chicago Press, 1962), 166. 2 2See Steven Shapin, and Simon Schaffer, Leviathan and the Air Pump: Hobbes, Boyle, and the Experimental Life (Princeton: Princeton University Press, 1985); Bruno Latour, We Have Never Been Modern, trans. Catherine Porter (Cambridge: Harvard University Press, 1993); Steven Shapin, A Social History of Truth: Civility and Science in Seventeenth Century England (Chicago: University of Chicago Press, 1994). ^Social constructionism is "the idea that the meaning of the body is changeable... culture may shape the body...the body has no enduring natural language" in Ann Snitnow, " A Gender Diary," in Feminism and History, ed. Joan Wallach Scott (New York: Oxford University Press, 1996), 513. 11 concentrated on how science constructs knowledge about gender. Evelyn Fox Keller, in her ground breaking book, Reflections On Gender and Science (1985), shares nine essays in which she explores how concepts of gender are constructed through representations of the body and how these representations are specifically influenced by the concept that "science is bound up with the idea o f masculinity." 2 4 According to Keller, the social and political forces that shape science are part o f a patriarchal ideology that casts objectivity, reason, and mind as male, and subjectivity, feeling, and nature as female. Science, in the west, has been produced almost exclusively by white, middle-class men and has been promoted as an objective activity, as opposed to, "deeply personal as well as social activity." 2 5 Keller argues that such concepts o f gender influence the production of science and are an important consideration in the analysis o f traditional scientific theories and methods. The earliest research to apply these feminist assumptions in the study of P M S grew out o f the social sciences where new methods were developed to emphasize the role o f culture in its production. The best known work in the early feminist psychology literature on P M S is that o f Mary B r o w n Parlee, Barbara Sommer, and Randi Koeske. In a 1973 article titled "The Premenstrual Syndrome," Parlee argued that control groups of non-menstruating individuals were rarely used in P M S research and the absence of such controls biases the explanatory theorizing. 2 6 In 1974, Parlee pointed out that the most common questionnaire used in P M S assessment almost entirely focused on negative symptoms,27 and, in a 1982 article that appeared in Psychology of Women Quarterly, Parlee 2 4 Evelyn Fox Keller, Reflections on Gender and Science (New Haven: Yale University Press, 1985), 3. 2 5 Keller , Reflections on Gender and Science, 7. 2 6 M . B . Parlee, "The Premenstrual Syndrome," 454-465, cited in Zita, " The Premenstrual Syndrome," 192. 2 7 M . B . Parlee, "Stereotypic Beliefs About Menstruation," 229-240, cited in Zita, "The Premenstrual Syndrome," 191. 12 noted that there were discrepancies between subjects' daily self-reports and reports in which they were asked to recall past menstrual experiences. Parlee argued that this discrepancy possibly reflects cultural stereotypes.28 Sommer noted in 1982 that while 8-13% of women suffered from disabling abdominal cramps during menstruation, this figure did not lead the medical community to promote these symptoms as a universal female disease, as they were prompted to do with P M S . 2 9 Finally, Koeske's ground breaking work in 1983 suggested that the labeling o f premenstrual phase emotional states may be more dependent than we think on external environmental and cultural cues. 3 0 Empirical research on P M S , like that conducted by Parlee, Sommer, and Koeske, developed in conjunction with the women's self-help health movement in the United States during the 1970s, a movement that focused on women taking responsibility for their own health. The goals o f this movement are most clearly articulated in the Boston Women's Health Book Collective's, Our Bodies, Ourselves, first published in 1973. 3 1 This publication was largely concerned with the consequences o f a male-centered health care system, the political and cultural barriers to women's full and fair participation in the health care system, and the desire to transform the existing medical care system. 3 2 2 8 M . B . Parlee, "Changes in Moods and Activation Levels During the Menstrual Cycle in Experimentally Naive Subjects," Psychology of Women Quarterly 7:2 (1982): 119-131, cited in Zita, "The Premenstrual Syndrome," 195. 2 9 B . Sommer, "Menstrual Distress," in The complete book of women's health, eds. Gail Hongladarom, R. McCorkle , and Nancy Woods (New Jersey: Prentice Hall , 1982), pages not available, cited in Zita, "The Premenstrual Syndrome," 193. 3 0 Randi Koeske, "Lifting the Curse o f Menstruation: Toward a Feminist Perspective on the Menstrual Cycle," Women and health 8 (1983): 1-16, cited in Zita, "The Premenstrual Syndrome," 204. 3 1 Boston Women's Health Book Collective, Our Bodies, Ourselves: A Book By and For Women (New York: Simon and Schuster, 1973), 1-23. 3 2Rebecca Dresser, "What Bioethics Can Learn from the Women's Health Movement," in Feminism and Bioethics: Beyond Reproduction, ed. Susan M . W o l f (New York: Oxford University Press, 1996), 145. 13 Our Bodies, Ourselves marks the beginning o f women's efforts to reclaim their bodies from the medical establishment. It also marks the development o f both political activism and theorizing about the effect that the medicalization of normal life processes has had on western culture. One o f the earliest studies to specifically apply a woman-centered perspective to the discussion o f menstruation is Susan S. Lichtendorf s, Eve's Journey: The Physical Experience of Being Female, published in 1982. It is a comprehensive exploration of the female body and how women change throughout the life cycle. In her section on "premenstrual tension," she focuses on encouraging women to "break the silence about premenstrual tension." 3 3 Lichtendorf s efforts to draw a marginalized subject forward are exemplary o f the consciousness-raising that characterized early feminism and the women's self-help health movement in the 1970s and 1980s. Sophie Laws, Valerie Hey, and Andrea Eagan each published essays that reflect a more radical feminist and social constructionist3 4 point o f view in their edited collection, Seeing Red: The Politics of Premenstrual Tension (1985). 3 5 Laws ' essay, "Who Needs P M T ? A Feminist Approach to the Politics of Premenstrual Tension" (1985), argues that P M T is a political construct used to oppress women's behaviour when it does not conform to social norms. She argues that one o f these norms restricts women from expressing anger and that when women express distress or anger the Susan S. Lichtendorf, Eve's Journey: The Physical Experience of Being Female (New York: G . P. Putnam's Sons, 1982), 136. 3 4 Radical feminist, social constructionism is a rejection o f the idea that "one can discover a universal 'truth' about biology beneath social distortions." It seeks to describe "social meanings themselves and how competing social definitions interact" in Sophie Laws, Issues of Blood: The Politics of Menstruation (London: The MacMil lan Press Ltd . , 1990), 28. 3 5Sophie Laws, Valerie Hey, and Andrea Eagan, Seeing Red: The Politics of Premenstrual Tension (London: Hutchinson, 1985). 14 feeling is invalidated by blaming it on their 'Temale bodies." 3 6 Valerie Hey provides a specific example of this invalidation in her essay, "Getting Away with Murder: P M T and the Press" (1985). Hey provides a feminist critique of media coverage in the British trials of Christine English and Sandie Smith in 1981, arguing that P M T was a mechanism used by the medical and legal establishments for dealing with female "difference."3 7 The utilization of a P M T defence marginalizes other possible sources o f female anger, problematizing women's bodies by explaining female violence in terms o f their biology, but not problematizing the male behaviour that contributed to the violent outcome. 3 8 Eagan's essay, 'The Selling of Premenstrual Syndrome: Who Profits from Making P M S 'The Disease o f the 1980s?'," turns its attention toward treatments for P M S . Eagan questions the use o f progesterone in the treatment of P M S , arguing that the commercial interests of pharmaceutical companies who manufacture and sell it take precedence over the ethics o f its distribution. Research in the 1980s had not provided evidence that P M S is caused by a hormone deficiency, and no clinical trials had been conducted to test the efficacy and safety o f progesterone suppositories. Many physicians, however, prescribed progesterone as a treatment for P M S anyway. 3 9 Laws, Hey, and Eagan each argue that the institutions o f medicine, law, and business privilege male-centered value systems and knowledge. They argue that the narrative on premenstrual changes in women is shaped by the values and knowledge that are embodied by these institutions and it is women's right and responsibility to challenge this narrative and attempt to re-write it. 3 6Sophie Laws, "Who Needs P M T ? A Feminist Approach to the Politics of Premenstrual Tension," in Seeing Red, 59. 3 7 Hey, "Getting Away with Murder," in Seeing Red, 66. 3 8 Hey, "Getting Away with Murder," in Seeing Red, 79. 3 9 Andrea Eagan, "The Selling o f Premenstrual Syndrome: Who Profits from Making P M S 'The Disease of the 1980s?'," in Seeing Red, 83. 15 Many of the challenges to this narrative were first conceptualized by feminists who worked as physicians or scientists in the United States during the 1980s, including feminist biologist Ruth Bleier. Bleier edited an early collection of papers by feminist scientists presented at a symposium, Feminist Perspectives on Science, at the University of Wisconsin, Madison, in Apr i l 1985. Elizabeth Fee's paper in this collection, "Critiques o f Modern Science: The Relationship of Feminism to Other Radical Epistemologies" (1986) reports that, "in the early stages o f the women's movement, science and technology remained at the periphery of [feminist] vision. Consciousness-raising and the construction of theory began with women's immediate experience and extended in time and space to history and anthropology...At the core of the women's movement were the politics of personal relationships, sexuality and reproduction." 4 0 Since the 1970s, the production and application of scientific knowledge has moved toward the center o f contemporary feminist theory and practice, and feminist theory and practice have increasingly been considered in the production of scientific knowledge. Bleier points out that feminists who participated in the early stages o f developing a feminist science hoped to change a science that had "evolved within a patriarchal society, developed a decidedly masculine tone, became distorted by a pervasive male bias, systematically excluded women from training and participating in science...and was, furthermore, most effective in propagating stereotypes o f 'the feminine' that made it seem self-evident that women were unsuited for 'penetrating' nature's mysteries."4 1 In the introduction to Feminist Approaches to Science (1986), Bleier summarizes some of 4 0Elizabeth Fee, "Critiques of Modern Science: The Relationship of Feminism to Other Radical Epistemologies," in Feminist Approaches to Science, ed. Ruth Bleier (New York: Teachers College Press, 1986), 42. 4 1 Ruth Bleier, 'Introduction," in Feminist Approaches to Science, 1. 16 the principles that might characterize feminist science, principles that are identifiable in the work of U B C and SFU' s psychology students working on P M S . First, scientists need to acknowledge that they like everyone else have values and beliefs that affect how they practice science. Second, they need to explore how these subjectivities specifically affect their perspectives, approaches, and actual scientific methods. Third, scientists should be explicit about their assumptions, open in their interpretations of each study and its significance, and clear in describing the limitations o f their findings. Lastly, they must be responsible in the language they use to convey their results to the scientific and nonscientific public. 4 2 While feminist scientists, like Bleier, suggested methodological changes that might characterize feminist science, researchers in the humanities developed theories that challenged male-centered ideologies of science. Cynthia Eagle Russell's Sexual Science: The Victorian Construction of Womanhood (1989) has demonstrated that the development o f scientific models to explain sex differences between men and women has had a long history. She traces this history to the emergence o f biology in the early eighteenth century and later to Charles Darwin's theory of evolution, which enshrined the idea that "women's nature, like men's, was rooted in their biology. It was nature, not nurture, that mattered."43 In a 1990 article, "The Definition of Male and Female: Biological Reductionism and the Sanctions of Normality," Gisela T. Kaplan and Lesley J. Rogers discuss the debate over "human nature" in more general terms than does the historical study by Russett. They argue that it is significant that "as the feminist movement gained momentum in the 1960s and 1970s it almost immediately met arguments and theories which countered questions concerning power, status, and 4 2 Ruth Bleier, 'Introduction," in Feminist Approaches to Science, 5-16. 4 3 Cynthia Eagle Russett, Sexual Science: The Victorian Construction of Womanhood (Cambridge: Harvard University Press, 1989), 2. 17 freedom with biological answers concerning innateness."44 Arguments against women's equality have had little legitimate claim in biological facts and often theories of biological sex difference have been invoked to maintain the status quo and "explain" women's inferiority. Most studies, as do traditional studies o f P M S , imply that genetic and/or hormonal differences between the sexes have determined the sex differences in behaviour, largely ignoring the impact o f social variables. Kaplan and Rogers point out that after the 1960s when women began to demand rights to enter the business world, a set o f biologically-based arguments about the negative behaviours said to occur as symptoms o f "premenstrual tension" were applied to all women, "presumably to raise doubts about women's suitability for certain professions."4 5 The radical feminist perspective adopted here argues that equality can only be brought about by exposing the fallacies of belief systems which condone social inequalities of women based on pseudo-scientific arguments.46 Feminist sociologists have taken a particular interest in belief systems and the way that they influence knowledge about P M S . Sophie Laws ' recent monograph, Issues of Blood: The Politics of Menstruation (1990), is an empirical study of cultural attitudes toward menstruation and is designed to open up the subject o f menstruation, a topic which has long been guarded by secrecy. Through an examination of medical textbooks and interviews with ordinary men about their ideas on menstrual ^Gisela T. Kaplan, and Lesley J. Rogers, "The Definition of Male and Female: Biological Reductionism and the Sanctions o f Normality," in Feminist Knowledge: Critique and construct, ed. Sneja Gunew (New York: Routledge, 1990), 207. 4 5 Kaplan, and Rogers, "The Definition o f Male and Female," in Feminist Knowledge, 207. ^Kaplan, and Rogers, 'The Definition of Male and Female," in Feminist Knowledge, 208. For other expressions of this view see Marian Lowe, and Ruth Hubbard, Woman's Nature: Rationalizations of Inequality (Toronto: Pergamon Press, 1983), 1-147, and Ruth Hubbard, The Politics of Women's Biology, 107-140. 18 problems, Laws provides "an analysis of male political power over women which regards such domination as socially rather than biologically created." 4 7 Laws argues that a purely biological view of P M S is misdirected and that sociological studies demonstrate that social values influence the definition, meaning, and understanding of P M S , regardless o f its cause which as o f yet remains unknown. Laws says, "the meaning o f menstruation for many people in many circumstances relates only very dimly to biology, and derives far more strongly from the intricate social rules that people in society attach to it ." 4 8 Laws borrows the term etiquette from Leslie White to describe these social rules which she argues are enforced by '"social sanctions, such as adverse comment or criticism, ridicule, and ostracism'." 4 9 Sociologist, Mari Rodin, also emphasizes the role of social rules in shaping knowledge about P M S . In her article, "The Social Construction of Premenstrual Syndrome," she argues that when social norms are threatened, as in the case of a drastic change in gender roles for women, the social utility of a disease category like P M S becomes greater than the medical reality that scientists are able to offer. She suggests, by this, that people often misinterpret and misuse the tentative and limited results of scientific research to confirm already held beliefs and prejudices. She argues that shared cultural knowledge is what is reflected in knowledge about P M S . Several inconsistencies in the literature lead her to this conclusion; for example, vast discrepancies in the reported prevalence o f P M S , disagreement over which days are considered to comprise the premenstrual phase, uncertainty about the cause and definition of P M S , and the poor quality of standardized questionnaires.50 These 4 7 M e g Stacey, "Foreword," in Issues of Blood, x i . 4 8 Laws, Issues of Blood, 43. 4 9 Laws, Issues of Blood, 43. 5 0 M a r i Rodin, 'The Social Construction of Premenstrual Syndrome," Social Science and Medicine 35:1 (1992): 55. 19 are issues that have been addressed in the methodology o f various feminist psychologists, including some o f the student researchers examined in this thesis. In addition to the contribution o f feminist sociologists, such as Laws, Hey, Eagan, and Rodin; feminist psychologists, such as Parlee, Sommer, and Koeske; and feminist scientists, such as Bleier, Fee, and Keller, the most recent research on P M S in the field of psychology has begun to draw on gender studies and the history o f sexuality for new methods and conceptual frameworks to be used in analysis. During the 1980s, disputes within women's history over the degree to which humans change over time resulted in the outgrowth o f a new field called gender history. Within this field, new emphasis was placed on hierarchical social, economic, and political contexts rather than biology, and history rather than nature was emphasized in explaining the identities of women and men. 5 1 Women's history continued to pre-suppose the object of its inquiry; that is to say, that female difference was accepted as a fact of nature and not as a result of historical context. Historian, Joy Parr explains that the "self-conscious move towards the study of gender, rather than woman...began from the poststructuralist premise that identities [are] made in relationships."5 2 Parr further explains that gender "is a term feminist theorists developed to explain how being male or female is not simply the result of biology but is socially constructed and reconstituted... Theoretical and empirical studies o f gender are concerned with examining this relationship, particularly the inequalities and hierarchies o f authority and power that have underpinned relations between women and men." 5 3 Gender theory has provided feminist researchers in other fields, including the science driven fields of biology and 5 1 Joy Parr, "Gender History and Historical Practice," in Gender and History in Canada, eds. Joy Parr, and Mark Rosenfeld (Toronto: Copp Clark Ltd . , 1996), 14. "Parr, "Gender History and Historical Practice," in Gender and History in Canada, 14. 5 3 Joy Parr, 'Introduction," in Gender and History in Canada, 1. 20 psychology, with a framework for problematizing the concept of natural sex, and the existence o f biologically-based differences between men and women. A s the research in this thesis will show, psychology research on P M S since the 1980s has increasingly considered the array of dimensions that shape identity and begins from the premise that identities are indeed made in relationships. A recent study, in the history o f sexuality, that suggests some o f the dimensions increasingly considered by psychologists who research P M S is Becki Ross ' The House That Jill Built: A Lesbian Nation in Formation (1995). Ross argues that gender is not just about heterosexual interaction but is conceived of through social discourses that include homosexual, transgendered, bisexual, cross-dressing, and asexual individuals, indicating that gender is not homogeneous as has been commonly thought. The over-generalizations that are made about homosexuality are more indicative o f assumptions that are external to the categories, and are often used to confirm existing societal beliefs. Ross introduces concerns voiced by both feminists o f colour and lesbian feminists who have challenged the universal category of "woman," demanding that historians recognize the relative instability of categories used in analysis. Ross concludes that "efforts to describe and analyse contradictions that arise in the process o f identity production suggest new possibilities for historicizing and explicating how identity itself becomes a site o f multiple and conflicting claims." 5 4 Psychologists working on P M S in the Vancouver area since 1983 have increasingly provided a measure of the social context described by Ross in The House That Jill Built. More generally, they have adopted, in varying degrees, the theoretical and methodological concerns raised by this literature review. Most significantly, they have challenged the masculinist voice o f biomedical approaches to Becki L . Ross, The House That Jill Built: A Lesbian Nation in Formation (Toronto: University of Toronto Press, 1995), 231. 21 P M S , they have challenged the depiction of negatively evaluated changes in women, they have challenged the claim that female "nature" is deviant when compared to male "nature," and they have challenged the claim that the expression of anger contradicts the feminine role. Vancouver Research Projects on PMS The psychology projects under examination can roughly be mixed into three periods: 1983-1985, 1985-1992, and 1992-1997. Studies conducted between 1983 and 1985 include Hol ly Prochnau's B A . graduating essay, her M A . thesis, Judith Youdale's M A . thesis, and Jessica McFarlane's M A . thesis. The work in this earlier period identifies male biases in social science research and applies feminist theory in its deconstruction o f stereotypes about women. Studies conducted between 1985 and 1992 include Judith Youdale's Ph.D. dissertation, Jessica McFarlane's Ph.D. dissertation, Delores Escudero's M . A . thesis, and Cheryl Fraser's M . A . thesis. The work in this middle period is divided. Youdale, McFarlane, and Fraser continue to draw on feminist theory, and in varying degrees they also implement the feminist methods that had been developing in psychology since the earlier period. Escudero, on the other hand, works within a biological determinist framework where she assumes that sex differences exist and are rooted in biology. Among the feminist methods applied by Youdale, McFarlane, and Fraser are: adding criteria to the questionnaires that reflect positive menstrual experiences, examining menstruation in the context. o f other cycles, gathering both retrospective and prospective data 5 5 for analysis, and keeping the "Retrospective data is based on recollections. The data is gathered by having respondents answer questions about symptoms experienced in past menstrual cycles. Prospective data is based on daily reports. The data is gathered by having respondents 22 menstrual purpose of the study concealed from participants. The use of feminist research techniques leads to conclusions that challenge traditional psychological and biomedical models o f P M S . Finally, work in this last period includes only Shelley Moore 's Ph.D. dissertation. Moore 's work draws on feminist theories and methods, but also on newer developments in gender studies. She argues that current research must also consider the inter-relationships between stress, experience o f abuse, age, ethnicity, and sexuality in producing P M S . She recognizes that individuals belong to numerous categories simultaneously and depending on the context, accent or downplay their membership in one or another category. The wide variety o f approaches to P M S research, even in this relatively short time-span, change in their definition, diagnosis, and application suggesting the extent to which knowledge about P M S is culturally constructed. Through the culture o f feminist influenced psychology since the 1980s, P M S has increasingly been constructed as a condition that is highly dependant on social values and meanings. The first work examined is the undergraduate and master's research o f Hol ly Prochnau, completed at Simon Fraser University between 1983 and 1984. Prochnau's research at both the undergraduate and graduate levels grew out o f a body o f work in psychology that became popular in the 1970s and 1980s, called cognitive psychology. One branch of cognitive psychology focused on establishing that there are sex differences in intellectual ability and that these differences "may be explained by looking for biological sex differences in the development, structure and functioning o f the brain." 5 6 B y the 1980s, as mentioned, feminist scientists and psychologists began to challenge biological theories o f sex difference, arguing that they falsely serve to essentialize common beliefs answer questions about symptoms experienced in the present menstrual cycle. 5 6 Ruth Bleier, "Sex Differences Research: Science or Belief?" in Feminist Approaches to Science, 149. 23 about differences between men and women. Feminist researchers, including Prochnau, challenge traditional models by building their own research on the assumption that there are no intellectual differences between men and women, and that women's intellectual ability is not a correlate of her reproductive functions. In her B . A . graduating essay, Prochnau reviewed a number o f psychology studies that found "a significant change in cognitive task performance across the menstrual cycle," a change that was suggested to be caused by menstrual hormones which "appear" to affect intellectual and emotional processes.5 7 In the early 1980s, such conclusions often translated into the popular belief that women's concentration, memory, and dexterity is affected by menstruation and menstrual hormones. Prochnau's essay, "Conjugate Lateral Eye Movement, the Menstrual Cycle, and Oral Contraceptives" (1983), studied the relationship between menstruation and intellectual ability in women, concluding that women's intellectual performance is not impaired by menstruation. She remarks that in "recent decades women continue to be affected by cultural ideas concerning their menstrual cycle. In the male-oriented society, women are expected to ignore any discomfort that might accompany this monthly cycle and behave as much like males as possible." 5 8 She identifies a systematic bias against women and sets out to deconstruct stereotypes about women by applying feminist principles in her work. At the M . A . level, she maintains the view that traditional psychology research is biased by a male-centered society and perspective. Prochnau's M A . thesis, "Hemisphericity and Contraceptive " H o l l y Prochnau, "Hemisphericity and Contraceptive Behaviour" ( M A . thesis, Simon Fraser University, 1984), 14. 5 8 Hol ly Prochnau, "Cojugate Lateral Eye Movement, the Menstrual Cycle, and Oral Contraceptives" ( B A . honours essay, Simon Fraser University, 1983), 19. 24 Behaviour" (1984), explores the relationship between oral contraceptive use and the intellectual abilities of women. She found that intellectual performance was neither impaired nor improved with the use of oral contraceptives, suggesting that reproductive hormones have no influence on the intellectual abilities of women. While Prochnau recognizes that societal beliefs may influence a researcher's assumptions, she does not consider how they also might be built into the organizing features of psychology, including its methods. Prochnau accepts both that P M S has a physiological cause and that the tests and questionnaires she uses are scientific, objective measures of intellectual ability. Feminists who argue that the concept of universal "objectivity" is actually an androcentric social construction, would find conflict in Prochnau's simultaneous belief in objectivity and woman-centered science. This points to one o f the inherent tensions within feminist science, a tension that continues to characterize the discipline. The second work examined was completed by another Simon Fraser student, Judith Youdale, whose work spans both the early and middle periods under study. Youdale's research is oriented toward clinical practice and developing useful techniques for use in diagnosing and treating P M S . Prior to the 1980s, there was considerable debate over the existence and nature of a premenstrual syndrome. The trials in Britain during 1981 kindled debates over the definition and validity o f P M S with some researchers setting out to confirm its legitimacy and to standardize diagnostic criteria 5 9 for d i a g n o s t i c criteria for P M S are set out in "Appendix A " of the DSM-III-R, and are as follows: A . Symptoms must occur in the week before menstruation. B . At least five o f the following symptoms must be present in the week before menstruation: sadness, anger, anxiety, depressed mood, decreased interest in usual activities, fatigue, difficulty concentrating, change in appetite, hypersomnia or insomnia, and physical symptoms, such as, breast tenderness, bloating, headache. In addition, at least one of symptoms 1,2,3 or 4 in this list must be present. C. The disturbance must interfere with work, social activities, or relationships. D . The disturbance must not be an exacerbation o f another disorder, such as depression or anxiety. E . The diagnosis may be based on retrospective reports of symptom experience but it must be confirmed by daily self-25 the purpose of treatment. In 1986-1987, while Youdale worked on her Ph.D. dissertation, the American Psychiatric Association was in the process o f deciding whether or not to include P M S in the Diagnostic and Statistical Manual of Mental Disorders. The decision to include P M S in the DSM-III-R appendix produced mixed reactions by feminists. Some felt it medicalized P M S , taking control away from individual women and reducing their experiences to inaccurate generalizations that would be projected onto all women. Others, including Youdale, felt that its inclusion symbolized a recognition by the medical community that P M S was not "all in the head" and from henceforth funding would go into P M S research and treatment services. Youdale's M . A . thesis, "Construct Validation of Premenstrual Syndrome" (1984), empirically investigates the validity o f P M S as a diagnostic entity. 6 0 Youdale's study compares women who identified themselves as P M S sufferers with those who identified themselves as non-sufferers,61 concluding that the P M S profile o f self-identified sufferers is not as clear as previous research suggests. She also found that 33% of the women who recalled no premenstrual changes actually met diagnostic criteria for P M S , suggesting to her that "diagnostic criteria fail to distinguish between severe P M S sufferers and those who experience symptoms but perceive them to be only minorly disruptive."62 To counterbalance this failure, she uses a greater number and variety of questionnaires in conducting her Ph.D. research. Youdale's dissertation, "Relationships o f Retrospective and Prospective Reports o f ratings during at least two cycles. See American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3d ed. rev., 369. ^Judith Youdale, "Construct Validation of Premenstrual Syndrome" ( M . A . thesis, Simon Fraser University, 1984), 114. 6 1 Youdale administered retrospective and prospective questionnaires to gather her data. 6 2 Youdale, "Construct Validation o f Premenstrual Syndrome," 118. 26 Premenstrual Depressive Change to Pathological Indicators, Menstrual Attitudes, Attributional Style and Stress" (1990), adopts a more explicitly psychological model for P M S research. Until 1982, P M S research had proceeded from the observation o f cyclic changes in physiology. A t this time, however, the biologically-based perspective on P M S was supplemented by a more traditionally psychological one. Here, the starting point o f inquiry is the psychological changes occurring over the menstrual cycle. This shift in perspective resulted in the advancement of psychological hypotheses concerning the cause and expression of P M S . Youdale argues that psychological research has investigated psychological changes without questioning the cause o f P M S , implicitly endorsing a physiological hypothesis. Youdale drew on several psychological theories of P M S , including theories that suggest the possible influence o f stereotypic beliefs about menstruation, and theories that suggest attitudes toward menstruation affect self-perceptions of P M S . These theories enable her to construct a method that problematizes the physiological hypothesis of P M S , shifting her perspective to include social, as well as, biological processes as possible factors that produce menstrual change. 6 3 The third work examined was completed by University of British Columbia student, Jessica McFarlane, whose work, like Youdale's, spans both the early and middle periods under study. McFarlane's M A . thesis, "Actual and Perceived M o o d Fluctuations: A Comparison o f Menstrual, Weekday and Lunar Cycles" (1985), challenges "the classic premenstrual mood pattern" 6 4 by examining mood changes in the context o f several other cycles including menstrual, lunar and 6 3Judith Youdale, "Relationships of Retrospective and Prospective Reports o f Premenstrual Depressive Change to Pathological Indicators, Menstrual Attitudes, Attributional Style and Stress" (Ph.D. diss., Simon Fraser University, 1990), 42. ^Jessica McFarlane, "Actual and Perceived M o o d Fluctuations: A Comparison o f Menstrual, Weekday and Lunar Cycles" ( M . A . thesis, The University o f British Columbia, 1985), 2. 27 weekday cycles, as well as testing her hypothesis on both women and men. B y introducing these methods she hopes to show that the menstrual cycle is not abnormal when compared to other cycles experienced by women, and that cyclical mood changes are not unique to women and do not necessarily coincide with the menstrual cycle. McFarlane administered both retrospective and prospective questionnaires to gather her data. She found that, prospectively, "there were no group differences and no menstrually-related mood fluctuations. The retrospective reports, however, indicated systematic bias." 6 5 M e n were assigned to pseudo-menstrual cycles so that their mood changes could be measured over a 28 day period, simulating the female menstrual cycle. Women recalled more negative moods during the premenstrual and menstrual phases than men, but both groups reported weekday fluctuations, and no groups reported mood changes coinciding with the lunar cycle. McFarlane concludes that "stereotypes (both well and ill-informed) influence recollections o f mood," 6 6 and that the discrepancy between prospective and retrospective data challenges dominant stereotypes about women and men. She argues that the results of her study contradict the "stereotype that women are 'more changeable' than men, especially premenstrually or menstrually,"6 7 and the popular notion that women are'Victims of their raging hormones." 6 8 She believes that the omission of men from earlier studies may have led researchers to persist in the stereotype that women are more emotional than men, and the evidence that both men and women experience mood cycles "indicates that treating emotional fluctuations as unhealthy symptoms, and assuming that women usually manifest them is misleading." 6 9 McFarlane's hypothesis 6 5 McFarlane, "Actual and Perceived M o o d Fluctuations," i i . ^McFarlane, "Actual and Perceived M o o d Fluctuations," i i . 6 7McFarlane, "Actual and Perceived M o o d Fluctuations," 17. 6 8McFarlane, "Actual and Perceived M o o d Fluctuations," 24. 6 9McFarlane, "Actual and Perceived M o o d Fluctuations," 25. 28 has the potential to explain widespread self-reports o f P M S in light of empirical evidence indicating most women do not experience P M S . McFarlane's Ph.D. dissertation, "Premenstrual Syndrome in Context" (1992), further develops the argument that there is a measurable difference between actual and perceived experiences of P M S and that this results from the influence of cultural stereotypes on women's recollection o f premenstrual mood change. McFarlane's results are consistent with several theories about P M S , "especially some of the recent feminist theories,"70 including theories that P M S is an outlet for women who believe the expression of anger contradicts the feminine role, theories that P M S behaviour is not abnormal by comparison with men's behaviour, theories that women who have negative attitudes toward menstruation report more P M S , and theories that see P M S as a metaphor for a general lack o f control over their lives. 7 1 McFarlane says it is important to distinguish between the types of premenstrual and menstrual changes, especially so that healthy changes should not be confused with symptoms "which by definition indicate an illness or disorder." 7 2 McFarlane's research reflects the mentorship of Tannis MacBeth Williams and her experience with feminism and feminist psychology, a resource that none of the S F U researchers had available to them. The development o f this collaboration in P M S research at U B C has led to recognition, in psychology, as well as, in women's health as measured by the publications associated with McFarlane's research. The results o f her master's and doctoral research were co-published with Williams in Psychology of Women Quarterly and Canadian Psychology. This suggests that her work 7 0Jessica McFarlane, "Premenstrual Syndrome in Context" (Ph.D. diss., The University of British Columbia, 1992), 73. 7 1McFarlane, "Premenstrual Syndrome in Context," 6. 7 2McFarlane, "Premenstrual Syndrome in Context," 77. 29 was accepted by peers at both a journal specializing in women's issues and a journal representative o f Canadian psychology generally. McFarlane's solo publication reaches an even wider audience, appearing in the 1998 edition of Behavioral Medicine and Women: A Comprehensive Handbook.13 This book is designed as a reference book for clinicians in women's health care, providing theoretical understandings and practical applications within a behavioural model. McFarlane's chapter "Premenstrual Disorders" provides an overview of the P M S research field, discussing both biomedical and socio-psychological approaches to P M S . The publication o f McFarlane's work in a general companion to women's health suggests that feminist approaches to P M S are no longer only o f interest to women's audiences, but to the wider community of health professionals. The fourth work examined was Delores Escudero's M A . thesis, 'The Influence o f Shift Work and Menstrual Cycle Phase On Depression and Other Symptoms Reported B y Female Nurses" (1990). Escudero examined whether working night shifts has health consequences for female nurses and whether these consequences vary according to the menstrual cycle of the subjects.74 The impetus for her study was a theory that associates premenstrual symptoms, with those found in poor shift work adaptation, including symptoms o f depression.7 5 Escudero places her work within the larger framework o f biological rhythms research, a relatively new area in psychology, most often focused on human performance but typically not inclusive of females in its studies. Where McFarlane adopted a socio-psychological approach to cycles research, Escudero adopts a biologically determinist 7 3Jessica Motherwell McFarlane, "Premenstrual Disorders," in Behavioral Medicine and Women: A Comprehensive Handbook, eds. Elaine E . Blechman, and Kelly D . Brownell (New York: The Guilford Press, 1998), 457-462. 7 4Deldres Escudero, "The Influence o f Shift Work and Menstrual Cycle Phase on Depression and Other Symptoms Reported by Female Nurses" ( M A . thesis, Simon Fraser University, 1990), i i i . "Escudero, "The Influence of Shift Work ," 33. 30 approach that views cycles as "evolutionary adaptations that can anticipate environmental changes by means of a time-keeping biological mechanism." 7 6 Escudero's concept of feminism is limited to an acknowledgment that women are under-represented in cycles research and that generalizations growing out of P M S research fail to account for individual characteristics that might contribute to greater vulnerability to symptom experience. She found that different women develop different types of P M S (sub-syndromes), with different levels o f impairment, and that individual differences and different sub-syndromes, such as anxiety and depression, must be looked at before reaching a conclusion. 7 7 Escudero's knowledge o f socio-psychological approaches to P M S , however, does not influence her own method o f research, nor her view that internal biological rhythms are most likely responsible for P M S depression, just as they are likely responsible for shift work depression. The last o f the studies conducted in the middle period was Cheryl Fraser's M . A . thesis, "Performance o f Women on Measures of Actual and Perceived Cognitive Functioning Across the Menstrual Cycle," completed in 1993, also at Simon Fraser University. Her research revealed no support for the hypothesis that there is a premenstrual deficit in cognitive performance. L ike her predecessor, Holly Prochnau, Fraser questions the justification and rationale for research that is "motivated by the 'common belief that women are unable to concentrate, tliink clearly, or perform well intellectually during the premenstrual/menstrual phase."78 She claims that cognitive performance research is a feminist concern because the stereotype that "the menstrual cycle affects intellectual 7 6Escudero, "The Influence o f Shift Work," 1. "Escudero, "The Influence of Shift Work," 89. 7 8 Cheryl Fraser, "Performance of Women on Measures of Actual and Perceived Cognitive Functioning Across the Menstrual Cycle" ( M . A . thesis, Simon Fraser University, 1993), 1. 31 performance still prevails." 7 9 She argues that subjectively reported cognitive change or "be l ie f in change by female subjects "is often misrepresented by researchers and the popular media," and that although its acceptance as a Late Luteal Phase Dysphoric Disorder ( L L P D D ) 8 0 diagnostic criterion shows that it has gained credibility, "it is important to stress that those findings are not supported by objective findings of cognitive performance."8 1 Fraser concludes that, as a diagnostic criterion for Late Luteal Phase Dysphoric Disorder, cognitive deficit should be questioned until further research is conducted. Even i f some women claim that they suffer from a cognitive impairment during their premenstrual phase, "concurrent measures of subjective cognitive ability do not support their claim." 8 2 She fears that given the acceptance o f Late Luteal Phase Dysphoric Disorder as a psychiatric disorder, women who believe they are affected by their menstrual cycle wil l be inappropriately assigned a psychiatric diagnosis 8 3 when tests o f cognitive impairment would show otherwise. She argues that this diagnosis has "ramifications for women everywhere. This common, although unproven, assumption can lead to discrimination against women in the workplace, and seriously affect women's self-perceptions as well as their place in society." 8 4 Fraser's work is politically charged and more explicitly feminist than Prochnau's earlier work on the same topic. In the ten years that separate their work there were considerable developments 7 9Fraser, "Performance of Women," 3. 8 0 Late Luteal Phase Dysphoric Disorder ( L L P D D ) is the term used, in the Diagnostic and Statistical Manual of Mental Disorders 3d ed. rev., to classify the condition commonly known as P M S . 8 1Fraser, "Performance of Women," 4. 8 2Fraser, "Performance of Women," 52. 8 3Psychiatric diagnosis is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders. For the specific criteria used to diagnose P M S see footnote 59. 8 4Fraser, 'Terformance of Women," 53. 32 in feminist theory and its application to P M S research, yet Fraser never questions the concept o f objectivity in science. Like Prochnau, Fraser simultaneously considers herself a feminist and scientist. Fraser's view is consistent with a view of feminism that sees discrimination against women as originating from the misuse of scientific information, and not from misguided assumptions within the fundamental methods and theories of science. This again raises the point that feminist research is not o f a single mind and that philosophical differences between feminists commonly persist. The sixth and last work examined was Shelley Moore 's dissertation, 'TJnderstanding Women's Use o f the Label ' P M S ' , " which she completed at the University o f British Columbia in 1997. Moore's project is the only work in the last period under study and represents the most recent direction of study in P M S research. Moore 's work is intimately connected with that o f her U B C colleague, Jessica McFarlane, because through their shared supervisor, Tannis MacBeth Williams, they took part in a long term research project that was conducted on the same sample o f research participants over the five years that separated the completion of their dissertations. McFarlane focused on the significance of placing the premenstrual cycle within the larger context o f other cycles that could conceivably affect mood, while Moore built her hypotheses around a question that was raised but not examined by McFarlane in 1992: what is different in some women's lives that they choose not to use the P M S label? 8 5 Moore structures her research around this question, focusing on the specific cultural attributes that contribute to the use or rejection o f the P M S label. She found that only 16% of participants in McFarlane, "Premenstrual Syndrome in Context," 77. 33 her study met the criteria for P M S , 8 6 yet 60% believed they currently had P M S . 8 7 Women's attitudes toward menstruation most strongly related to self-designation and women who said that they currently had P M S were more likely to view menstruation as "debilitating, natural, and predictable."8 8 Women in this group also reported higher scores for depression and experience of anger, as well as, greater reports of emotional and physical abuse as children and adults. Moore concludes that women's representations o f the menstrual cycle were "neither simple reflections o f cultural stereotypes nor pervasively negative, but rather diverse and complex." 8 9 The results that link depression, anger, and specific forms o f abuse with self-designation suggests, that women indicating P M S may have difficulties that "may or may not be menstrually-related."9 0 Moore suggests several explanations for women's use of the P M S label, including: perceptions of stressors such as work and family, relationship satisfaction, power dynamics within a relationship (yet to be tested empirically), and performance o f gender-violating behaviours. It is noteworthy that some studies report that women who are involved in sexual relationships with men report more P M S than those who are not. Moore did not consider sexuality in her study because "only one woman identified as a lesbian," 9 1 but she did consider that sexuality may be a relevant variable in future studies. She believes researchers and other professionals need to "assess the nature o f those difficulties in women presenting with P M S . " 9 2 She writes, "relatively little research has 8 6 For the specific criteria used to diagnose P M S see footnote 59. 8 7Shelley Moore, "Understanding Women's Use of the Label ' P M S ' " (Ph.D. diss., The University o f British Columbia, 1997), i i . 8 8 Moore , "Understanding Women's Use of the Label ' P M S ' , " i i . 8 9 Moore , "Understanding Women's Use of the Label ' P M S ' , " iv. 9 0 Moore , "Understanding Women's Use of the Label ' P M S ' , " iv. 9 1 Moore , "Understanding Women's Use of the Label ' P M S ' , " 19. 9 2 Moore , "Understanding Women's Use of the Label ' P M S ' , " iv. 34 addressed how the women who are 'objects' o f this definitional discourse interpret ' P M S ' . " 9 3 To address this lack of research, Moore explores the meaning of self-labeling by systematically examining "factors related to women's choices to label themselves as having or not having P M S . " 9 4 According to Moore, future research must involve longitudinal studies that keep participants naive to the purpose of the study. The studies need to be longitudinal so experiences o f P M S can be measured over time and across many stages in the life cycle. The studies need to be blind to minimize participant bias in the reporting o f data, and to improve the validity of results. Each o f these measures, it is believed, will help move research toward a contextualized conception of P M S . In early research that focused on biomedical models o f P M S , results were inconclusive and inconsistent. A s Moore ' s research shows, new results have been achieved by introducing social and psychological theories to the study o f P M S . Conclusion and Directions for Future Study During the 1980s, some psychologists began to develop social theories for explaining P M S , largely because they were dissatisfied with the biomedical models that failed to provide an understanding of its cause(s) and offer effective treatments. This development occurred simultaneously with the development o f feminist theories that grew out of the women's movement o f the late 1960s and 1970s. In varying degrees, feminism influenced the theories and methods of scholars working in psychology, a phenomenon that is observable in the research projects examined 9 3 Moore , "Understanding Women's Use of the Label ' P M S ' , " 2. 9 4 Moore , "Understanding Women's Use of the Label ' P M S ' , " 3. 35 here. The earlier work o f Hol ly Prochnau, Judith Youdale, and Jessica McFarlane, between 1983-1985, recognized the prevalence of male bias in social science research and set out to deconstruct the knowledge that was produced within that framework. Their work added to a small, but growing body of psychology that emphasized feminist perspectives on P M S . McFarlane and Youdale's work continued to evolve through the completion of their Ph.D.s in the early 1990s. Their Ph.D.s reflect a more sophisticated and well developed body o f feminist theory and methods, including a substantial number of psychology studies and literature outside the field. Cheryl Fraser and Shelley Moore also cited literature from outside o f psychology suggesting that in certain areas o f psychology the division that privileges scientific materials over non-scientific materials is diminishing. I would also suggest that this is a measure of the emphasis that has been placed on interdisciplinarity at Canadian universities in recent years. The work completed by McFarlane and Youdale between 1990 and 1992 reflects an attempt to remodel psychological theories about P M S using not only feminist theories but also feminist methods. Each o f them develops an elaborate discussion o f methodological critiques that accumulated in the P M S literature and they try to address these in their own work by implementing research designs that are sensitive to the limitations and questionable quality o f standardized questionnaires, the need to collect both prospective and retrospective data and the need for blind, longitudinal studies i f reliable results are to be obtained. The work of Delores Escudero, and to an extent the work o f Prochnau and Fraser, stand in opposition to the strongly social approaches of McFarlane, Youdale, and Moore. Escudero's comparison between the menstrual cycle and shift work is based on biologically determinist assumptions that run counter to the radical feminist and social constructionist point o f view. The contrast between these two conceptions o f feminism—the social constructionist and essentialist— 36 points to the continuing divide within feminism over the gender similarities and differences debate. Shelley Moore's 1997 Ph.D. dissertation is the last work in this study and an example o f the new direction that P M S studies in psychology have taken. Beyond restructuring psychological research using feminist theories and methods, she adopts gender methods in her research. Gender methods enable Moore to consider the multitude of variables that influence P M S and how these variables are interpreted differently by researchers and study participants. She observes that the use of the P M S label is influenced, not only by stereotypes and attitudes toward menstruation, but also other life circumstances including perceptions o f stress created by work, family and friends, experiences of physical and emotional abuse, age, ethnicity, and sexuality. She suggests that future studies must explore the interaction between a number o f variables that might influence self-designations of P M S , as well as, researcher designations of P M S . While the scope of this work does not include a comparison between P M S and other topics in the history of women's medicine, a more substantial project might explore the connection between other disorders that are often characterized as "female", such as hysteria, depression, chronic fatigue syndrome, and eating disorders: The connection between these "disorders" and cultural ideas about women's sanity and the female reproductive system have yet to be explored from a historical perspective and on a comprehensive scale. This study would also have benefited from a series of oral history interviews that might have provided information not contained within the formal structure o f a graduating essay, thesis, dissertation, or scholarly publication. Through interviews, it might be possible to gain a better understanding of each researcher's personal goals for choosing to research P M S and attitudes about themselves as scientists and feminists. It would also be a useful way to address questions left open ended by the research examined, for example, what they feel are the 37 limitations o f research that involves human subjects and the use of self-report methods. One final suggestion for future directions in the history o f P M S , is the suggestion for a broader and more comprehensive study o f similar sources. The case study model is useful on a small scale, providing evidence for a hypothesis about one, select Canadian community. I would further suggest that a similar pattern can be found in the research o f psychologists across Canada, the United States and other western countries. 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