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Social Factors in the Psychology of Menstruation, Birth, and Menopause
Abstract
Information about possible social influences on the psychology of reproduction, supplemented by a clinical understanding of the psychodynamics of the individual and scientific knowledge about the effects of hormones on behavior, provides insight into the experience of a particular woman in a particular social milieu. Such insight is an appropriate basis for effective treatment of many of the clinical problems in the area of psychosomatic obstetrics and gynecology.
... In general, a woman's perception of her own period (and how normal this was) was more likely to be related to her own past experiences than local norms (in terms of what other women in the locality were reporting). Parlee (1976) believed that culturally accepted norms (such as the notion that the 28 day cycle is typically normal) affect reporting of and investigation of periods. ...
Objective: To explore the relation between pre-operative psychiatric morbidity and actual menstrual loss, and psychiatric outcome after endometrial ablation for heavy periods. Design: Prospective cohort. Setting: Leeds General Infirmary. Subjects: Women presenting consecutively in the gynaecology out-patient department awaiting endometrial ablation for heavy periods. Main outcome measure: Psychiatric status at fifteen months post-operatively using the semi-structured interview, Present State Examination. Results: 120 women were eligible for study. 12 declined and a further 16 did not proceed past the initial stages for a variety of reasons (including very low actual menstrual loss, organic pathology requiring alternative treatment and failed clinic attendance). 92 women received endometrial ablation and were followed up. 75 women agreed to collect menstrual sanitary towels and tampons. 49% had an actual loss of less than 80 millilitres (the cut-off recognised by gynaecologists as representing heavy loss). 24% had less than 40 millilitres. Of the original 108 women presenting, 58% had significant psychiatric morbidity. Most of this morbidity involved symptoms of depression and anxiety. Of seven women counselled from surgery because of low actual loss, 6 had significant psychiatric morbidity. Of the 14 women who were psychiatric 'cases' before and after operation 9 of them had actual losses that were less than 80 millilitres. Psychiatric morbidity fell post-operatively to 21.8%. When looking at different sub-groups, women with the best outcome (6% post-operative psychiatric morbidity) are those with genuine heavy loss and no pre-operative psychiatric morbidity. Those who fare worst (37% post-operative psychiatric morbidity) are women with preoperative psychiatric morbidity and low actual menstrual loss. Conclusions: Psychiatric status and actual menstrual loss should be considered when exploring the possibility of surgery for women with heavy periods.
... According to the biocultural perspective, although menopause is defined as a biological event, the experience of this biological event is shaped by physiological and cultural factors (Abe and Moritsuka 1986;Beyene1986;Dowty et al. 1970;Flint and Samil 1990;Frey 1981;George 1988;Griffin 1977;Kaufert et al. 1981;Look et al. 1988;Malacara et al. 2002;Maox et al. 1970;Parlee 1976;Skultans 1970;Weideger 1976). ...
A menopauza a nők életének egyik legtermészetesebb állapota, amely legtöbb esetben sem orvosi, sem mentálhigiénés beavatkozást nem igényel. Az emberek nagy része mégis problematikus életszakasznak tekinti, amely során olyan komoly testi, lelki változások mennek végbe, amelyekkel csak nehezen lehet megküzdeni. A menopauzát gyakran maguk a változókorú nők is a szépség, a nőiesség elvesztésének élik meg. A helyzetet nehezíti, hogy a fejlettebb nyugati társadalmak tömegkommunikációja a fiatalságot dicsőíti, ami a kedvezőtlen életérzéseket erősíti. Ugyanakkor, ha megvizsgáljuk, hogyan tekintettek a menopauzára a történelem során, kiderül, hogy a klimaktérium negatív megítélése korántsem a XXI. századhoz köthető, hanem sokkal régebbi hagyományokra tekint vissza. Azt sem szabad elfelejteni, hogy mint minden nagyobb léptékű változás az életben, legyen az akár örömökkel vagy nehézségekkel teli időszak, az alkalmazkodóképességünket teszi próbára. A szakirodalom ezeket az élethelyzeteket nevezi normatív krízisnek. A menopauza során pedig nem csupán a testi működésben, hanem az élet számos területén, így a családi, társadalmi szerepekben bekövetkező változások is kihívás elé állítják a nőket. A folyamat komplexitása miatt a menopauza kérdésköre biopszichoszociális megközelítést igényel. Ennek szellemében íródott a fejezet is, amely betekintést nyújt a klimaktérium során lezajló biológiai, szociális és pszichés változásokba, valamint bemutatja a változókorban felmerülő problémákat és intervenciós lehetőségeit.
Menopause is regarded as the consequence of a chain of events that leads to a change in programming along the hypothalamic-pituitary-gonadal axis. The mechanism of the biological clock that initiates the onset of neuroregulatory changes leading toward menopause is unknown. What is known is that the ensuing steady state of gonadotropin secretion causes ovarian noncyclicity, and with further passage of time ovarian function diminishes and the blood levels of ovarian estrogens decrease to only small, barely detectable amounts. This notion unfortunately led to the development of the concept of menopause as a disease. Adopted primarily by medical practitioners, menopause has become synonymous with a state of estrogen deficiency, which is to be treated with hormone replacement therapy (HRT).
Health care for midlife women in the United States of the 20th century is a complex blend of myth and reality viewed against a backdrop of rapid social change. The myths that have evolved concern women’s roles, specifically older women’s roles, and also include menopause, an event that occurs most often at midlife. Until recently, little information has been available concerning the health or health care of midlife women. Most research on women’s health at midlife is clinically oriented and assumes that menopause is the most important aspect of women’s lives and health. Although this has changed somewhat in recent years, in part due to the impetus of women’s groups such as the Menopause Collective in Cambridge, Massachusetts, and the National Women’s Health Network, much needs to be changed before we have research that validates women’s experiences as well as providing them with the information that they can use to make appropriate decisions for their own health.
The role and potential relevance of estrogen and other sex steroids to psychiatric disorders is the focus of current scientific attention. Estrogen has been described as a 5-HT, NA and ACh agonist; it also modulates DA2 receptors. This chapter reviews the implications to the reproductive life cycle of women. Specifically, it discusses the impact of hormonal fluctuations during menarche, premenstrually, during pregnancy and postpartum, and perimenopausally.
The current paper reviews and evaluates available research on the influence of pregnancy on sexuality. Patterns of findings consistent across most studies include a decline in sexual interest and in sexual behavior of women during the third trimester of their pregnancy. Changes in sexuality during earlier stages of pregnancy are less clearly established. The limited number of investigations used different methodologies, each with significant shortcomings. While some consistency in the pattern of sexual change is evident, there has been little attempt to identify the underlying factors accounting for such change. The methodology of investigations of the influence of pregnancy on sexuality can be improved by standardizing assessment procedures, combining longitudinal and cross‐sectional methodologies, including assessment of the pregnant woman's partner, and providing adequate descriptions of methodology.
Bipolar manic-depressive women are considered a special risk for recurrence of a childbirth-related affective episode. In a chart study of 40 fathers who are former bipolar patients, 21 had histories of an affective episode in proximity to a wife's pregnancy. When these bipolar fathers were compared with the 19 for whom no such episodes were recorded, differences were found on several parameters. Therapeutic implications of the findings are considered, and recommendations for further study are offered.
To describe the pattern of menstrual and nonmenstrual symptomatology and to clarify the number, kind, and severity of symptoms that women report in relation to the menstrual cycle, a study of university-employed women was conducted. A cross-sectional correlational approach to survey data was used. The sample consisted of 633 generally healthy women aged 21 to 44 years. Results indicated that a wide range of variability in terms of the number of symptoms reported and the mean severity level was experienced. Additionally, a variety of different types of symptoms (somatic, affective, concentration, and behavioral) were reported
The lifetime prevalence of mood disorders in women is approximately twice that of men. The underlying causality of this gender difference is not yet understood. There is increasing scientific attention to the modulation of the neuroendocrine system by fluctuating gonadal hormones. Here, we highlight the role and potential relevance of oestrogen and other sex steroids to psychiatric disorders specific to women from menarche to menopause in addition to the relationship between sex hormones, neurotransmitter function and mood disorders related to the reproductive lifecycle in women. The sudden appearance of higher levels of oestrogen in puberty alters the sensitivity of the neurotransmitter systems. Moreover, the constant flux of oestrogen and progesterone levels throughout the reproductive years portends constant modification of the neurotransmitter systems. Premenstrual syndromes may be the result of an altered activity or sensitivity of certain neurotransmitter systems. Pregnancy and delivery produce dramatic changes in oestrogen and progesterone levels, and significant suppression along the hypothalamic-pituitary-adrenal axis, possibly increasing vulnerability to depression. At menopause, oestrogen levels decline while pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels increase. The loss of modulating effects of oestrogen and progesterone may underlie the development of perimenopausal mood disorders in vulnerable women. The pattern of neuroendocrine events related to female reproduction is vulnerable to change and is sensitive to psychosocial, environmental and physiological factors. Further research is needed to identify specific genetic markers that might help us better understand how the balance between oestrogen, progesterone, testosterone and other steroid hormones affect neurotransmitter function.
Three classes of postpartum psychiatric disorders have been identified: post-partum psychoses, nonpsychotic postpartum depression, and transitory “postpartum blues.” This review covers recent research concerning the prevalence, clinical course, and etiology of both nonpsychotic postpartum depression and postpartum blues. Etiological factors discussed include demographics, precipitating stressful events in the perinatal period, inadequate social support, predisposing psychological characteristics, and physiological abnormalities.While emotional lability in the first few days following delivery (postpartum blues) may be hormonally based, considerable evidence suggests that more prolonged postpartum depression is closely linked both to stressful events around the time of pregnancy and delivery and to a lack of adequate social support. Prior history of depressive episodes is also a good predictor of nonpsychotic postpartum depression. It is recommended that future research on postpartum psychiatric syndromes should consider more complex etiological models that recognize the interplay of environmental, psychological, and physiological variables.
Midlife has received recent attention but is still difficult to define. Women's developmental phases are most appropriately understood as different from men's, with a complex integration of biological context, family development and roles, and individual development. Menopause has been considered a determining event, and a variety of symptoms have been attributed to menopausal changes. Emerging data indicate that menopause does not appear to be responsible for most of the symptoms. Midlife stresses are the result of a combination of personal, family, social, and biological variables, with postmenopausal development an important phase.
This paper focuses on a patient's presentation of symptoms that in another culture are labeled with a serious medical diagnosis. In Western medicine, isolated phenomena of hypnogogic and hypnopompic hallucinations and sleep paralysis are considered transient sleep disturbances unless they occur as part of the tetrad of narcolepsy, but despite reassurances, the described patient continued to see himself as seriously ill until he was able to share the full scope of his apprehensions with the therapist.
The purpose of this investigation was to evaluate the relationship between climacteric status and health symptoms across age cohorts in 522 African American women aged 25-75. Data were collected through home interviews and subjected to hierarchical regression analyses. In the overall sample a direct relationship was found between climacteric status and physical health symptoms but not mental health symptoms. A direct relationship between climacteric status and both physical and mental health symptoms was found for the younger age cohort 25-34. There was a direct relationship between climacteric status and physical health symptoms but not mental health symptoms for the 35-44 age cohort. The relationship between climacteric status and physical and mental health symptoms held despite controls for education, income, marital status, and body mass.
The present study was performed in order to clarify the characteristics and etiological factors of the maternity blues syndrome. This syndrome was diagnosed by means of a questionnaire and interviews on the fifth day postpartum. This syndrome was investigated in terms of psychological, obstetrical, environmental, and endocrinical background.
The results obtained were as follows:
1) About 8% of the women in our study experienced this syndrome in the first five days after childbirth. As most of the blues subjects had felt much better within a month after birth, the syndrome was considered to be of a temporary nature.
2) As for the symptoms themselves, not only psychological complaints, but somatic complaints were characteristic.
3) This syndrome was associated etiologically with a tendency toward neurosis, a cluster of obstetrical variables including older delivery age, primipara, evidence of pregnancy complications, an abnormal mode of delivery and the nuclear family.
4) Multiple regression analysis showed that psychological and obstetrical factors accounted for at least 15% in depression scores following childbirth.
5) It was suggested that self-limiting components played an important role in its onset.
6) As to the endocrinical aspect, in the blues subjects that were both younger than twenty-five years old and primiparous, the serum DHEA-S level on the fifth day postpartum showed a significant increase compared with the control. Therefore, it was suggested that DHEA-S dynamics played a major part in the occurrence of this syndrome.
The perception and experiences of menopause vary cross-culturally. However, the lack of physiological symptoms such as hot flashes, in some cultures, calls for more explanations beyond social and cultural factors alone. Like other developmental events, menopause is a biocultural experience. Therefore, research on menopause should consider biocultural factors such as environment, diet, fertility patterns and genetic differences that may be involved in the variations of menopausal experience.
Between about ages 40 and 55 years, women experience a transition known as the menopause, which marks the end of their childbearing years. Although the most striking feature of the menopause is the cessation of menstruation, other biologic and psychosocial events occur and can be classified as stressors and "facilitators". For a predisposed group of women the stressors are likely to cause psychiatric disorders. At the same time, the facilitators are opportunities for personal growth and development. Physicians who understand both types of events during this phase of life and who are sensitive to the overall effects of ageing on marital partners can provide comprehensive care to the menopausal patient rather than automatically pursuing drug therapy (substitution hormonal therapy) alone.
Although significant correlations exist between perceptions-of health and the presence of symptoms, the exact nature of that relationship is unclear. This study investigated whether women’s subjective appraisal of their psychological well-being (PWB) differed in relation to self-reports of menstrual and nonmenstrual symptoms in order to determine whether the identification of symptom source as menstrual contributed to changes in PWB. The sample (n=633) consisted of healthy women between the ages of 21 and 44. A cross-sectional correlational approach to the survey data was used and data were collected through a structured questionnaire, which included the General Well-Being Schedule and the Moos Menstrual Distress Questionnaire. The degree of association among the independent variables (symptoms, sociodemographic, and health factors) and the dependent variable (PWB) was analyzed by multiple correlation regression. Results indicated a strong relationship between the independent variables when analyzed as a set and PWB (R=.86). Number, type, and severity of symptoms accounted for more of the variance in PWB than did the source (menstrual and nonmenstrual) of the symptom (p<.001). Although women experienced specific menstrual symptoms, the presence of these symptoms did not negatively affect their assessment of PWB; rather, these women had a higher PWB than those with nonmenstrual symptoms. Such findings help clarify misconceptions about the effect of menstrual-cycle symptoms on women’s mental health.
Studies indicate that women experience higher rates of mental illness than do men. The basis of this difference in mental health status is unclear. The purpose of this study was to clarify whether self‐reports about the method, safety, and reliability of fertility regulation, the presence of menstrual symptoms, and specific social factors influence employed women's psychological well‐being (PWB). A cross‐sectional correlational approach to survey data was used. Data were collected through a structured questionnaire that included the General Well‐Being Schedule and the Moos Menstrual Distress Questionnaire. The sample (n = 633) consisted of healthy women between the ages of 21 and 44 years. Through multiple correlation/regression and chi‐square analysis techniques, relationships between and among the independent variables (menstrual symptoms, fertility regulation, and social factors), and the dependent variable PWB were examined. Results indicated that variations in PWB were related to safety and reliability of birth control method (p < .001), usualness of menstrual symptoms (p < .01), number of children (p < .025), effect of menstrual cycle on relationships (p < .05), and effect of the menstrual cycle on life in general (p < .05). The relationship between children in residence and PWB were nonsignificant, as was usualness of symptoms and birth control method. These results identify factors that have the potential to explain variations in women's mental health and can be viewed as progress toward explaining gender differences in mental health.
Sociocultural factors and medical science have shaped the basic ideas about the female role and her place in society. This paper discusses the influence of these ideas on current thinking about women and their health and raises design and methodological questions about past research. Additionally, current research emphasis in the field of women's health is explored.
It appears that menopause might be characterized by a major feature--change. Research is ongoing in biological, social and psychological areas and hopefully will aid us in achieving a more precise understanding of the characteristics of this subgroup of women at risk for psychiatric morbidity around the time of the menopause. Until the groups surveyed are more stringently defined and we achieve this understanding, it seems reasonable to approach such patients and their experience by individualizing their assessment and management.
Care offered to women with post-partum affective disorders is crucial to their present and future self-concept and their ability to bond with their infant. Nurses working in obstetrical units are becoming more aware of facilitating the natural bonding process and the staffs of psychiatric/mental health professionals also need to take this into account when working with mothers experiencing post-partum affective disorders. Currently there is much exciting basic research in post-partum illnesses and, it is hoped, in the future women will not have to endure extensive emotional trauma during the post-partum period. Meanwhile, it behooves nurses to help affected women and their families to cope with their experiences in the most productive, guilt-free manner.
Numerous physical and psychological symptoms have been attributed to the hormonal changes of menopause. Symptoms have also been attributed to loss of fertility, redefining of roles, empty nest syndrome, loss of femininity, and changes of status. Cross-cultural studies allow researchers to examine the contribution of physiological, psychological, and sociocultural influences to the experience of menopausal symptoms. Such research is complicated by differences between cultures in the definition of menopause, reproductive histories, symptom expression, and beliefs as to what constitutes status. A review of five important cross-cultural studies indicates that there are enormous differences in the experience of menopause among women in the same culture and among cultures. Menopausal symptoms seem to be caused by a combination of physical changes, cultural influences, and individual perceptions and expectations.
Menorrhagia may sometimes represent psychological problems. A frequent gynaecological response to this complaint is surgery. More recently, psychological factors and accurate assessment of menstrual loss have called into question the need for hysterectomy in a proportion of women. Endometrial ablation offers a less invasive alternative to hysterectomy which may result in a better psychological outcome.
The author's aim is to aid primary care physicians and obstetrician-gynecologists in correctly diagnosing and treating premenstrual dysphoric disorder (PMDD). The symptoms fluctuate markedly, but their timing is key. PMDD patients experience symptoms only during the luteal phase and will have a symptom-free interval after the menstrual flow and before ovulation. The author discusses self-report instruments, which are valuable tools for diagnosis when combined with the ICD-10 criteria for premenstrual syndrome (PMS) or the DSM-IV criteria for PMDD and the ruling out of medical and psychiatric conditions, such as diabetes, hypothyroidism, major depression, and dysthymia, that cause similar symptoms. Treatment strategies ranging from nonpharmacologic approaches such as dietary modification and aerobic exercise to pharmacologic interventions such as antidepressants, anxiolytics, and agents to suppress ovulation are examined.
The lifetime prevalence of mood disorders in women is approximately twice that of men. The underlying causality of this gender difference is not yet understood. There is increasing scientific attention to the modulation of the neuroendocrine system by fluctuating gonadal hormones. This review attempts to summarize our current state of knowledge on the role and potential relevance of estrogen and other sex steroids to psychiatric disorders specific to women from menarche to menopause. The sudden appearance of higher levels of estrogen in puberty alters the sensitivity of the neurotransmitter systems. Moreover, the constant flux of estrogen and progesterone levels throughout the reproductive years portends constant modification of the neurotransmitter systems. Premenstrual syndromes may be the result of an altered activity or sensitivity of certain neurotransmitter systems. Pregnancy and delivery produce dramatic changes in estrogen and progesterone levels as well as significant suppression along the HPA axis, possibly increasing vulnerability to depression. At menopause, estrogen levels decline while pituitary LH and FSH levels increase. The loss of modulating effects of estrogen and progesterone may underlie the development of perimenopausal mood disorders in vulnerable women. The pattern of neuroendocrine events related to female reproduction is vulnerable to change and is sensitive to psychosocial, environmental, and physiological factors. Further research is needed to be able to identify specific genetic markers which might help us better understand how the balance between estrogen, progesterone, testosterone, and other steroid hormones affect neurotransmitter function.
Reviews and discusses psychological studies of the premenstrual syndrome in 4 methodological categories: (a) studies reporting a positive correlation between specific behavioral acts and phase of the menstrual cycle; (b) those using retrospective questionnaires concerning symptom and mood changes; (c) studies involving day-to-day (self-) ratings of various behaviors, symptoms, and moods; and (d) thematic analyses of verbal material gathered in an unstructured situation throughout the cycle. The scientific status of the hypothesis of a premenstrual syndrome is considered, together with more general topics-in particular the question of control groups, the choice of a baseline for describing changes in behavior and the difficulties involved in physiological explanations of psychological phenomena. Brief consideration is given to publication practices of psychological journals as they affect the kind of scientific information available on behavioral changes associated with the menstrual cycle. (72 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A review of studies of social class and child-rearing behavior reveals a recurring pattern of inconsistent and contradictory findings. This paper reports the findings of a study of child-rearing attitudes expressed by women during the course of their pregnancies. The data suggest that child-rearing attitudes may be more closely associated with attitudes toward pregnancy than with social class. These findings are discussed in relation to other investigations insofar as existing contradictory findings might be explained from a conceptual rather than a methodological perspective.
A structural analysis of the parental role cycle pinpoints the factors which make the transition to parenthood more difficut than marital and occupational adjustment in American society: (1) lack of the cultural option to reject parenthood or to terminate a pregnancy when it is not desired, (2) the shift from marriage to the first pregnancy as the major transition point in adult women's lives, (3) abruptness of the transition at childbirth, and (4) the lack of guidelines to successful parenthood in our society. It is also suggested that every social role has the two independent axes of support and authority and that, contrary to expectation, the balance between expressive and instrumental activities is tipped toward a greater instrumental focus to the maternal role and to an excess of expressive activities in the paternal role, with the result that neither sex is adequately prepared for parenthood.
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Fifty-two pairs of female monozygous twins, discordant for motherhood and between 40 and 6o years of age, were investigated to find out whether motherhood has any long-time adverse effect on physical or mental health.
In this first part of the study the material is described and intrapair psychological differences existing before the probands' first pregnancy were focused on.
The probands were found to be much older at their first pregnancies than the primiparae of the general population. The origin of this we suppose to be the same as the origin of childlessness in the co-twins either on a biological or a psychological-social level.
In 8 pairs there was a difference in the mothers' preference for the twins during childhood. In 7 of these pairs the mothers were said to have preferred the proband. No such association between the fathers' preference and probandship was found.
Intrapair dominance bore no relation to probandship.
In respect of traits of early temperament the co-twins were more often described as serious-minded and introvert. However, probandship, temperament traits and intrapair dominance showed an intricate interrelation especially with regard to serious-mindedness.
Intrapair dominance was also associated with the co-twins' childlessness. Thus significantly more voluntarily childless co-twins were said to have been dominated by their twin partners.
The findings are discussed and it is concluded that even ideal control subjects are far from identical as far as psychological factors are concerned.
This investigation is concerned with the prevalence of dysmenorrhoea and premenstrual symptoms in the general population and with their relationship to personality.
Many authors have expressed the opinion that such relationships exist, but we will confine our review here to those studies which have presented supporting data. Wittkower and Wilson (1940) studied 57 patients with primary dysmenorrhoea and found there was a history of childhood maladjustment four times as often in these patients as in a control group. They considered that patients with dysmenorrhoea could be classified into two main personality types: the first, “characterized by deep resentment of their feminine role”; the second, “obviously immature physically and either shy or shut-in or chronically anxious and complaintive”. Sainsbury (1960) observed a significantly raised neuroticism score on the Maudsley Personality Inventory for patients attending hospital for dysmenorrhoea. Such views as these are not universally held, and would certainly not be shared by many gynaecologists. Nor are they supported by the little evidence forthcoming from population studies.
Nuckolls, K. B. (Yale University School of Nursing, New Haven, Conn. 06510), J. Cassel and B. H. Kaplan. Psychological assets, life crisis and the prognosis of pregnancy. Am J Epidemiol 95: 431–441, 1972.—This is a study of the relationships between psychosocial assets, social stresses as measured by a cumulative life change score and the prognosis of pregnancy. Psychosocial assets were measured early in pregnancy by a questionnaire (TAPPS) designed to assess the adaptive potential for pregnancy. At 32 weeks, subjects completed the Schedule of Recent Experience from which scores were calculated for life change during pregnancy and for the two years preceding it. Following delivery, the medical record was used to score each pregnancy as “normal” or “complicated.” Complete data were obtained on 170 subjects. Taken alone, neither life change nor TAPPS scores were significantly related to complications. However, when these variables were considered conjointly, it was found that if the life change score was high both before and during pregnancy, women with high TAPPS scores (favorable psychosocial assets) had only one third the complication rate of women with low TAPPS scores. In the absence of high cumulative life change, there was no significant relationship between psychosocial assets and complications.
Girls tend to learn menstrual euphemisms at menarche, usually from mothers and female friends. Boys usually report learning them in high school or college from male peers. Women often view the terms as a secret language for use in the company of males or others in whose presence a straightforward statement about menstruation is deemed embarrassing. Among men, menstrual euphemisms tend to have sexual and derogatory connotations. Interpretations which accompany these folk expressions are presented to illustrate general aspects of menstrual and sexual socialization.
This paper is primarily concerned with whether the social position occupied by pregnant women in Western society can be regarded as the same as that occupied by the sick. After an introductory discussion of some important sociological concepts consideration is given to the idea of a sick role as conceptualized principally by Talcott Parsons. It is suggested that for a variety of reasons, the state of pregnancy is in some ways different from “ordinary” illness and cannot be viewed in terms of any of the four expectations thought to be associated with the sick role. Intercultural and intracultural variations in conceptions of illness and pregnancy along with the unstructuredness of the state in Western societies are also briefly touched upon.It is argued that, although women who are pregnant occupy a special position in society and in certain situations fulfill unique expectations, this normal state cannot be considered a form of illness, and cannot ordinarily be viewed in terms of Parson's sick role paradigm.
: The increasing demand of women for a greater role in decision-making capacities and in professional areas raises persistent questions about the effect of menstrual cycle fluctuation on performance. A critical review of research on nonaffective correlates of the reproductive cycle is provided. The methodological problems inherent in such research, such as phase definition, determination of hormonal state, response bias, and generality of results are discussed. Studies using response measures based on self report and social behaviors indicate a behavioral decrement associated with the premenstrual and menstrual phases. Studies utilizing objective performance measures generally fail to demonstrate menstrual cycle related changes. Socially-mediated expectations are suggested as a possible basis for these contradictory findings. Copyright (C) 1973 by American Psychosomatic Society
Dysmenorrhea, nausea of pregnancy, pain in labor and infantile behavioral disturbances are conditions commonly considered to be caused or aggravated by psychogenic factors. Although such scientific evidence as exists clearly implicates organic causes, acceptance of a psychogenic origin has led to an irrational and ineffective approach to their management. Because these conditions affect only women the cloudy thinking that characterizes the relevant literature may be due to a form of sexual prejudice.
The methodological soundness of the Moos Menstrual Distress Questionnaire (MDQ) is considered. New data are presented which show that male (N =34) and female (N =25) subjects report very similar patterns of symptoms and symptom 'changes' when asked to indicate on the MDQ what women experience during the menstrual cycle. When the symptom scales on the MDQ are rank ordered according to the size of the 'changes', differences from intermenstrual phase, reported during the premenstrual and menstrual phases, the rankings of the female and male subjects are highly correlated (r = 0.88 for both menstrual and premenstrual 'changes'). While Moos has interpreted women's responses on the MDQ as evidence of 'premenstrual tension' or 'premenstrual syndromes', the results of the present study suggest an alternative interpretation in terms of stereotypic beliefs about the psychological concomitants of menstruation.
: Study of 100 postpartum patients pointed to a syndrome comprised of feelings of shame, helplessness, and confusion. Lack of difference between these patients and control subjects in performance on serial-7 subtractions and digit span as well as in frequency analysis of the EEG militates against the existence of a toxic delirious state. Conflict over assuming the mothering role was a central precipitating stress. For the most part, this conflict stemmed from the rejection of the patient's own mother as an adequate model and distorted communications about care of the infant. Problems in maternal identification may be accentuated in the puerperium by the neonate's incapacity to specify guidelines for his care. Since the ambiguities of infant care are greater in the early puerperium, this factor may, in part, account for the high recurrence rate of postpartum distress in these women as well as the onset of illness largely within the first 10 days postpartum. Copyright (C) 1968 by American Psychosomatic Society
because the view is held that a woman’s mental state is part of her obstetric condition. The ward sisters include in their reports comments on the patient’s emotional state. knowing that a psychiatrist comes to the ward regularly to see her patients, without her making a specific request. The obstetricians, paediatricians and psychiatrists meet to discuss cases. The close co-operation of obstetrician and paediatrician in itself has a beneficial effect on the patient’s mental state as she is kept well and promptly informed about an ill or premature baby. The paediatricians will talk with the mother at length if necessary, and this prevents many a puerperal breakdown and ensures a continuity of the mother’s interest and concern about her child, which often helps her have a satisfactory relationship with the baby in spite of his illness or prematurity. The psychiatrist working in this way has the opportunity to observe the healthy young mother, and this aids in assessing the distortions and illnesses of the puerperium. Perhaps therefore a short description of the normal mental state of a woman recently delivered in hospital would not be out of place. The night after delivery she may not sleep, from joy and excitement at having her new baby, and the strain of the labour. Later she tends to be rather touchy and vulnerable, sometimes quiet, withdrawn or depressed, rather weepy without knowing why-the well-known “baby blues” that happen on the third or fifth day. She is concerned about her own health and that of her baby and not much interested in anything else. She is not so different from any patient who has had an operation or is seriously ill, being withdrawn in her interest from the outside world, being more narcissistic than usual, so it can be assumed that the physical changes of labour contribute to her state. The big difference, of course, is that part of herself has become a baby and she is particularly concerned about this small and vulnerable part of herself. Winnicott [I] has described this state as “Primary maternal pre-occupation”, and has stressed its importance to the child because it is the beginning of the relationship between the mother and her baby and her commitment to bringing up her child
The development of a Menstrual Distress Questionnaire (MDQ) is described. Each of 839 women rated their experience of 47 symptoms on a six-point scale separately for the menstrual, premenstrual, and intermenstrual phases of her most recent menstrual cycle and for her worst menstrual cycle. The 47 symptoms were intercorrelated and factor analyzed separately for each phase, and eight basically replicated factors were extracted from each of these analyses. These fac- tors, which represent separate but empirically intercorrelated clusters of symptoms, were labeled pain, concentration, behavioral change, autonomic reactions, water retention, negative affect, arousal, and control. Scores on these eight clusters of symptoms were slightly correlated with age and parity. The scores were not af- fected by the specific menstrual cycle phase a woman was in when filling out the questionnaire or by the length of time since the woman had experienced the symptoms. Menstrual cycle symptom-profiles graphically depicting a woman's menstrual symptomatology were constructed and illustrated. The need for and utility of standard methods with which to measure menstrual cycle symptomatology is discussed.
(1)The female castration complex is viewed as the reaction to threat to feminine development. It is a complex of the interaction of significant persons, especially the mother, with the girl; this interaction is influenced by the cultural matrix.(2)Some results of a pilot study of 103 women were presented, indicating that:(a)Premenstrual symptoms are divided into two primary reactions: of helplessness and a need for love, or of defensiveness against anticipated attack; the symptoms are a constant compulsive recapitulation of devaluation of the self in relation to femininity; and(b)Symptoms of premenstrual tension and, to some extent, of dysmenorrhea and amenorrhea, are directly related to unpleasant, humiliating, or unloving experiences in relation to the mother.(3)As part of a sequence of experiences influencing the development and awareness of the self, the onset of menstruation is a nodal area of high potential for enhancement or impairment of the self, especially in relation to femininity.
This report deals with data secured from 110 cases which clinicians had diagnosed as the somatic symptoms of the naturally occurring menopause. The series is not selected and consists of all such patients seen in the Gynecology Clinic over a twenty-two month period.
The majority of clinicians appear to attribute menopausal symptoms to hormonal alterations. This is reflected by the large number of patients whose symptoms are treated with estrogens and by the numerous papers which report the success of this therapy. Behind this façade of accepted thought lies considerable difference of opinion. The disagreement relates to the proper duration of symptoms, the number of patients whose symptoms require estrogens, the degree of relief afforded by various hormonal preparations, the importance of psychological factors and even to what, exactly, are menopausal symptoms. There is also disagreement as to the role of hormonal alterations in the genesis of symptoms. In his review of the literature, Fluhman¹ found no correlations between menopausal symptoms and hormonal changes as indicated by laboratory data. He also listed clinical and experimental reasons why menopausal symptoms could not be attributed to the known hormonal alterations of the menopause and concluded that either (1) these changes may affect other glands (in a manner as yet undemonstrated) to cause the symptoms or (2) these hormonal changes and menopausal symptoms do not exist in a cause-and-effect relationship.
The original purpose of this investigation was a study of the relationship between estrogens and menopausal symptoms. A case history was secured from each patient prior to further study. It is felt that the data from these histories merit consideration by themselves. In part, these data support the observations of other authors whose work will be mentioned in the discussion.
Parenthood as a developmental phase
- Benedek
The psychopathology of vomiting of pregnancy
- Chertok
Social factors in the prediction and treatment of emotional disorders in pregnancy
- Gordon
Emotional and psychotic illness following childbirth
- Kaij
Selected studies of the menopause: an annotated bibliography
- McKinlay
A new look at menopause
- Neugarten
Social instability and attitudes toward pregnancy as a social role
- Rosengren
Psychological aspects of menstruation, childbirth, and menopause
- M B Parlee
Temporal data relating to the human menstrual cycle
- Presser
Cognitive, social, and physiological determinants of emotional state
- Schacter