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Qualitative Research in Psychology
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Challenging the Positioning of Premenstrual Change as
PMS: The Impact of a Psychological Intervention on
Women's Self-Policing
Jane M. Ussher a
aSchool of Psychology, University of Western Sydney, Australia
Online Publication Date: 01 January 2008
To cite this Article: Ussher, Jane M. (2008) 'Challenging the Positioning of
Premenstrual Change as PMS: The Impact of a Psychological Intervention on
Women's Self-Policing', Qualitative Research in Psychology, 5:1, 33 - 44
To link to this article: DOI: 10.1080/14780880701863567
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Qualitative Research in Psychology, 5:33–44, 2008
Copyright © Taylor & Francis Group, LLC
ISSN: 1478-0887
DOI: 10.1080/14780880701863567
33
UQRP1478-08871478-0895Qualitative Research in Psychology, Vol. 5, No. 1, January 2008: pp. 1–25Qualitative Research in Psychology
Challenging the Positioning of Premenstrual Change
as PMS: The Impact of a Psychological Intervention
on Women’s Self-Policing
The Impact of a Psychological Intervention on Women’s Self-PolicingJ.M. Ussher JANE M. USSHER
School of Psychology, University of Western Sydney, Australia
The positioning of the reproductive body as a site of madness or badness functions to
marginalize women and to medicalize their distress. Taking Premenstrual Syndrome
(PMS) as a case example, this paper rejects this pathologization and argues that self-
policing practices are associated with the experience and construction of premenstrual
change as PMS. Drawing on interviews with 12 British women, it is argued that
women’s experience of distress or anger premenstrually is connected to self-policing
practices of self-silencing, self-surveillance, overresponsibility, self-blame, and self-
sacrifice, and that their positioning of this distress as PMS takes place through a
process of subjectification. An outline is given of a woman-centred psychological
intervention, which identified and challenged these self-policing practices. It aimed to
allow women to develop more empowering strategies for reducing or preventing pre-
menstrual distress, build an ethic of care for the self, and no longer blame the body for
premenstrual anger or depression. Pre-intervention, the themes which emerged in
interviews were: PMS sufferer as split; self-silencing; and overresponsibility.
Post-intervention, the themes were: increased equality and agency; resisting patholo-
gization; and resisting self-sacrifice and overresponsibility. The implications for the
conceptualization and treatment of PMS and for the positioning of the reproductive
body as site of psychiatric disorder are discussed.
Keywords: premenstrual syndrome; psychological intervention; qualitative research;
self-policing; self-silencing; subjectification
It may seem perverse to position women as a potentially marginalized group, as in population
terms they form the majority. However, if women do not fulfill idealized constructions of
femininity they are at risk of being positioned as ‘other,’ as socially deviant, and as a
result become excluded by wider society or ostracized as undesirable. One of the ways in
which this process of marginalization occurs is through the medicalization of women’s
anger, distress, or socially deviant behaviour, tied to an abject reproductive body, wherein
individual women are positioned as epitomizing the ‘monstrous feminine’ (Ussher, 2006).
This medicalization, manifested by the focus on the reproductive ‘disorders’ premenstrual
syndrome (PMS), postnatal depression, and menopausal syndrome, serves to negate legit-
imate reasons for why women may be distressed, or may fail to emulate idealized woman-
hood through positioning them as suffering from psychiatric illness. Women are thus
treated biomedically in order to restore them to normative behavior; to bring them back
from the margins, marked by madness and social deviance, into the mainstream. This
Correspondence: Professor Jane M. Ussher, School of Psychology, University of Western
Sydney, Locked Bag 1797, Penrith South DC, NSW 1797, Australia. E-mail: j.ussher@uws.edu.au
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34 J.M. Ussher
paper will examine this argument and present an alternative approach to understanding
and ameliorating women’s distress through examining the case of PMS.
The focus on premenstrual changes as symptoms of psychiatric illness can be traced
to 1931, when the diagnostic category premenstrual tension (PMT) was first described and
attributed to accumulations of ‘the female sex hormone’ oestrogen (Frank, 1931). PMT
was renamed Premenstrual Syndrome (PMS) in 1953 because this disorder was seen to
contain a wider array of symptoms than tension, and in 2000 it was accepted as a psychiat-
ric category in the DSMIV and described as Premenstrual Dysphoric Disorder (PMDD)
(A.P.A., 2000). A significant percentage of women fall under this diagnostic rubric and
are thus at risk of being officially deemed mad once a month. According to epidemiologi-
cal research, 95% of women experience at least mild symptoms premenstrually, 40%
experience moderate distress (PMS), and 11–13% experience severe distress (PMDD)
(Steiner and Born, 2000).
The acceptance of PMS or PMDD as diagnostic categories to explain women’s
distress, dysfunction, or deviance in the premenstrual phase of the cycle has had an impact
beyond the clinical setting, with material consequences for women’s lives. PMS has been
used as a legal defense in crimes as disparate as shoplifting, road traffic offences, and
assault (Raitt and Zeedyk, 2000), reinforcing the positioning of the reproductive body as
site of both madness and badness. The premenstrual phase of the cycle is also positioned
as a time when feminine neurosis is at its peak (e.g., Lever, 1980). It has been claimed that
PMS makes women more likely to fail exams, crash cars, have accidents, commit suicide,
and suffer performance debilitation in the workplace (Dalton, 1968). Whilst there is insub-
stantial evidence for any of these assumptions and the research studies on which they are
based have been criticized for being methodologically unsound (Parlee, 1991), the publi-
cation of such ‘facts’ in self-help books (e.g., Shreeve, 1984) and in popular discourse
associated with PMS (Rittenhouse, 1991) acts to maintain the positioning of women as
second rate or other to men: a position of potential marginalization in society.
For the many feminist critics who vociferously argued against the inclusion of PMDD
in the DSM (Figert, 1996), PMS is positioned as merely the latest in a line of diagnostic
categories acting to pathologize the reproductive body and inappropriately attribute
distress or deviance to factors within the woman (Nash and Chrisler, 1997; Ussher, 1996,
2006). This view draws on broader post-modern debates in critical psychology and
psychiatry, where the very concept of mental illness or madness is contested as a discursive
construction that regulates subjectivity and a disciplinary practice that polices the population
through pathologization (Fee, 2000). Yet in emphasizing the regulatory power of dis-
course, postmodernism can be read as negating agency and failing to recognize the
existence of distress (Burr and Butt, 2000). It can also be seen to negate embodied or psy-
chological change across the menstrual cycle or other material aspects of women’s exist-
ence that may be associated with their premenstrual distress. This is problematic, as a
substantial proportion of women experience change during the premenstrual phase of the
cycle—of this there is no doubt (Hardie, 1997). Thus feminist critics could, paradoxically,
be accused of negating women’s experience of premenstrual distress.
PMS is not simply a rhetorical construction, a fiction framed as fact created by self-
proclaimed experts. Many women do feel angry, or depressed, or have a desperate need to
be alone at this time of the month. There are many complex reasons why these feelings
emerge at this time. There is convincing evidence from previous research that many
women experience increased vulnerability and sensitivity to emotions or external stress
during the premenstrual phase of the cycle (Sabin Farrell and Slade, 1999; Ussher and
Wilding, 1992). This results from a combination of hormonal or endocrine changes (Parry,
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The Impact of a Psychological Intervention on Women’s Self-Policing 35
1994), sensitivity to premenstrual increases in autonomic arousal (Kuczmierczyk and
Adams, 1986; Ussher, 1987) and differential perceptions of stress premenstrually (Woods
et al., 1998). Experimental research has demonstrated that dual or multiple task perfor-
mance is more difficult premenstrually (Slade and Jenner, 1980). While women can com-
pensate with increased effort, this can result in increased levels of anxiety (Ussher and
Wilding, 1991). It is thus not surprising that many women report reacting to the stresses
and strains of daily life with decreased tolerance premenstrually, particularly when they
carry multiple responsibilities (Ussher, 2003a). Indeed, in one study, career women with
child rearing responsibilities were found to report the highest levels of premenstrual
distress (Coughlin, 1990).
However, individuals do not experience the body in a socio-cultural vacuum.
Premenstrual change isn’t ‘pure,’ somehow beyond culture, beyond discourse; and it
is not simply caused by the reproductive body and by a syndrome called PMS. The
bodily functions we understand as a sign of ‘illness’ vary across culture and across
time (Payer, 1988). Women’s interpretation of physiological and hormonal changes as
being symptoms of PMS, rooted in the reproductive body, cannot be understood out-
side of the social and historical context in which they live and the meaning ascribed to
these changes by Western medicalized discourses. Premenstrual changes in state or
reactivity are positioned as PMS because of hegemonic constructions of the premen-
strual phase of the cycle as negative and debilitating (Parlee, 1994; Rittenhouse,
1991), which impact upon women’s appraisal and negotiation of premenstrual
changes in affect or sensitivity (Ussher, 2002). In cultures where PMS does not circu-
late as a discursive category, women do not attribute psychological distress to the pre-
menstrual body and do not position premenstrual change as pathology (Chrisler,
2002). ‘PMS sufferer’ is a position that women take up (or a position that they are put
in by others), and thus a position that women can resist or contest. The practices of
self-policing which leads to this positioning provides us with an explanation for
women’s experience of uncontrollable distress or anger premenstrually and dethrones
those who would position the abject body as being to blame (Ussher, 2004a).
In order to explore the processes of self-policing that result in premenstrual change
being positioned as PMS and the ways that this positioning can be resisted, this paper will
draw on interviews conducted with women who presented with moderate to severe pre-
menstrual distress and took part in an intervention study designed to reduce premenstrual
symptoms. It will demonstrate that PMS sufferer is a position that can be re-authored or
resisted, allowing premenstrual change to be reframed as a nonpathological process.
Method
Details of the interviews
Twelve British women who reported a 30% increase in premenstrual symptoms, as mea-
sured by prospective diaries over a three-month period, and who met DSMIV diagnostic
criteria for PMDD (A.P.A., 2000), took part in in-depth narrative interviews. The women
were randomly selected from a larger group, who were taking part in a controlled clinical
trial comparing medical and psychological treatments for moderate to severe premenstrual
symptoms. Twelve women from each of the treatment conditions (medical, psychological,
and a combination of the two) were randomly selected for interviews pre- and post-treatment.
This paper will draw on the interviews with the women in the psychological treatment
group.
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36 J.M. Ussher
Psychological intervention
The woman-centered psychological intervention developed for this study used a combina-
tion of narrative and cognitive-behavioral techniques to facilitate women’s re-authoring of
their experience of PMS, improve coping and reduce distress (Ussher, Hunter and Cariss,
2002). The aims of the intervention were to critically examine constructions of PMS and
femininity and how these constructions impact upon women’s positioning and experience
of premenstrual change; to examine life stresses and relational issues that precipitate dis-
tress; and to develop coping strategies for dealing with premenstrual change and distress
across the cycle. The intervention was offered on a fortnightly basis for eight sessions,
with one follow-up session.
Analysis
After transcription, pre- and post-intervention interviews were thematically line-coded.
Themes were grouped together and then checked for emerging patterns, variability, con-
sistency, commonality across women, and uniqueness within cases. This process follows
what Stenner (1993, p. 114) has termed a ‘thematic decomposition,’ a close reading to
separate a given text into coherent themes or narratives, which reflect subject positions
allocated to, or taken up by, a person (Davies and Harré, 1990). A number of themes
emerged in the pre-intervention interviews, including premenstrual change as pathology;
self-silencing; overresponsibility; and the juxtaposition of the good-bad woman. These are
summarized below and interpreted within a framework of subjectification. The main
themes in the post-intervention interviews were renegotiating relationships and overre-
sponsibility; awareness and repositioning of PMS; and care of the self.
Results
Self positioning as a PMS sufferer: A process of subjectification
Premenstrual change as pathology. Women who take up the position of abjection
personified, where premenstrual change is pathologized and the fecund body is posi-
tioned as cause of distress, do so through a process of subjectification (Ussher, 2003b).
Regimes of knowledge circulating within medicine, science and the law, which are
reproduced in self-help texts and the media (Chrisler, 2002), provide the discursive
framework within which women come to recognize themselves as PMS sufferers
(Ussher, 2004b). The representation of premenstrual psychological change as pathology
is the most pervasive truth about PMS, taken for granted in both popular and medical
accounts (Markens, 1996). This reflects the regimes of knowledge which currently dom-
inate Western conceptualizations of mental health, which posit that subjectivity, mood
and bodily experience should be consistent. This is based on a modernist position which
conceptualizes identity as unitary and the individual as rational and consistent, with
deviation from the norm as sign of illness. This results in premenstrual changes in emo-
tion or behavior being positioned as problematic. As one interviewee, Olga, said: “I find
that particular time of the month very difficult and I’m sure everybody else around me
finds it very difficult. There’s a big change in me and it makes me feel as if I’m not in
control.” The positioning of this change as a corporeal phenomenon, illustrated by
Lynne’s comment, “This change . . . there must be something that either goes wrong in
your blood chemistry at that time (or) your hormones are imbalanced”, reflects the
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The Impact of a Psychological Intervention on Women’s Self-Policing 37
pathologization of the reproductive body in popular cultural and bio-medical discourse
(Ussher, 2006).
Over-responsibility. The positioning of women as emotional nurturers of others, in partic-
ular men and children, necessitating women’s self-renunciation in order to legitimate their
taking disproportionate responsibility for caring, is central to constructions of idealized
femininity (O’Grady, 2005). When asked to talk about their PMS, women positioned their
major symptoms as not wanting or being able to provide unconditional care and support
for others and of wishing to divest themselves of overwhelming responsibility. They
judged their own desires or needs in relation to discursive constructions of woman as
responsible and emotionally nurturing, always able to offer unlimited care and attention to
others (Ussher, 2003a, 2006). As Angela said:
All I ever do is clean and cook and look after the kids and all I ever do is run
around and clean up after everybody. And I think, like I said for 3 weeks of
the month it doesn’t bother me cos I’m sure I’m doing it every week but it just
seems the week before my period I, I just don’t cope with that so well. I don’t
want to do that anymore [laughs] I want someone to look after me.
Self-Silencing. At the same time, women who reported PMS use a short fuse and a pres-
sure cooker metaphor to describe self-silencing for three weeks of the month over ‘silly’
irritations or more substantial relationship issues, which they ‘cope with’ or ‘don’t pay
attention to.’ This is self-silencing, which is broken premenstrually, as the frustration or
irritation becomes overwhelming because her own needs come to the fore or she cannot
(or does not want to) cope anymore (Ussher, 2003a). As Lisa commented:
It can be the, the silliest thing that one of the children has done. You know,
they will constantly come up and interrupt. That would drive me to, to scream-
ing pitch. Whereas in the other part of the month, the children can come up
constantly interrupting and I might say to them ‘I’m talking to Daddy and
you’re interrupting me,’ but when I’m pre-menstrual I would fly straight off
the handle and scream at them.
PMS becomes the descriptor for the irritation, depression or frustration which many
women experience in response to the unrelenting expectations of tolerance and coping
placed upon them. However, rather than being a symptom of PMS, a problem tied to the
body, these PMS symptoms could be conceptualized as an emergence of emotions that are
repressed during the majority of the month, and their outward expression through anger as
a rupture in the self-silencing that is central to women’s self-renunciation (Perz and
Ussher, 2006). This is illustrated by Nita’s experience:
I said ‘Nobody does anything round this house!’ and slam and stomp around a
bit. Or I’ll go on strike! [laughs] Where I don’t, where I won’t cook. I’ll say,
‘Right! If you’re not gonna’ do it I’m not gonna’ do it’, and tea doesn’t get
cooked or something like that.
Juxtaposition of the Good and Bad Woman. The juxtaposition of the good and bad
woman was also central to women’s positioning of themselves as having PMS, where the
premenstrual self epitomizes the monstrous feminine made flesh, and women use
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38 J.M. Ussher
metaphors such as Jekyll and Hyde to describe the premenstrual self (Cosgrove and
Riddle, 2003; Ussher, 2004a). As Margaret said, “I get cross with myself (1) because I
know, (2) I mean I know, I that I’m not myself. I know it’s not me.” Or as Mary said, “I
feel I’m, I’m almost like two people.” In many instances this splitting of the PMS and
non-PMS self leads to self-loathing. Tracy described PMS as “waking up in the morning
and looking at yourself in the mirror and saying ’I hate you, I hate you, I really, really hate
you.” A number of PMS/non-PMS contrasts appeared throughout the accounts: bad versus
good/perfect; introversion versus extroversion; out of control versus in control; irresponsi-
ble versus responsible; failing versus coping; angry versus calm; anxious versus relaxed;
sad/depressed versus happy; irrational versus rational; intolerant versus tolerant; vulnera-
ble versus strong; irritable versus placid; frustrated versus accepting (Ussher, 2002).
Implicit within these self-judgments were notions of the standards of behavior women
aspire to and are judged against: an idealized version of femininity that is hyper-responsi-
ble, able to cope and always in control. This reflected hegemonic representations of the
good woman juxtaposed with the bad: self-sacrifice, care, coping and calmness contrasted
with aggression, impatience and anxiety (Ussher, 1997).
Challenging women’s self-policing
Identifying and naming self-policing practices in order to challenge this process of
self-judgment can happen at the level of public discourse—feminist self-help texts, Web-
based information, newspaper, magazine articles, and books. It also needs to happen at an
individual level. Psychological interventions based within a narrative or constructivist
framework are one means of supporting women to identify and understand self-policing,
facilitating the process of the development of more agentive subject positions (O’Grady,
2005). To this end, a woman-centered psychological intervention was developed, which
addressed the complex interconnection between the material, discursive, and intrapsychic
factors that contribute to women’s premenstrual distress (Ussher, 1999) and facilitated
women’s re-authoring of their experience of PMS (Ussher, Hunter and Cariss, 2002). In a
random control trial conducted in the UK (Hunter et al., 2002b), where women were given
either serotonin response inhibitors (SSRIs) or took part in this psychological intervention,
narrative re-authoring was found to be as effective as SSRIs in reducing premenstrual distress
over a six-month period and more effective at the one-year follow-up. The post-intervention
interviews conducted with women illustrate the process of this change.
Re-negotiating relationships and overresponsibility
Being heard in a nonjudgmental way, having their feelings validated and receiving support
in relation to their distress, was reported by women to be one of the most positive aspects
of the intervention. It was as a result of feeling validated in this way that women were able
to develop more effective forms of communication with their partners and children in rela-
tion to experiences of anger, depression or irritation across the cycle, as well as in relation
to premenstrual feelings of vulnerability. This allowed them to feel understood, rather
than pathologized and dismissed: key factors which prevent sadness turning into depres-
sion (Stiver and Miller, 1988). Women were also more able to say no to unreasonable
demands, to establish more egalitarian practices within the home for the sharing of respon-
sibilities and to express deeper concerns within relationships when they were not feeling
overwhelmed premenstrually, all of which reduced premenstrual symptoms. This form of
intervention does not remove premenstrual changes, but it can reduce and depathologize
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The Impact of a Psychological Intervention on Women’s Self-Policing 39
them, empower a woman to ask for appropriate support and give her a greater sense of
agency in relation to her body. This is no longer a passive docile body, which requires
medical management, but a body (and mind), which is positioned as being within the
woman’s control. As Helen said, “I don’t think it’s cured or will cure PMT because I’ve
still got the feelings. Where it’s really helped me is in managing my PMT.”
As a result, all of the women reported alterations in their pattern of relationships with
others, which centered on women taking up a position of greater equality and agency, and
not pathologizing themselves in relation to difficulties in the relationship. The majority of
women reported the development of more honest and open communication of their needs
and concerns, which served to prevent the short-fuse and pressure cooker experiences of
repressed emotions spilling out premenstrually. Women also reported being more confident
in resisting the categorization by others of their behavior or feelings as PMS, which had pre-
viously led to a dismissal of their needs or frustrations. Many women described being more
tolerant of others premenstrually and coping better with relational issues that caused conflict
or distress, as they had learnt to let go of feelings of overresponsibility and were less likely to
position themselves as to blame when things were not perfect in the family.
Women were also more able to ask for help and support across the whole menstrual
cycle, moving out of a position of overresponsibility and into a position where they felt it
was legitimate to say no, or to share responsibilities with others. They reported being more
open to trying other ways of doing things, following greater understanding of the ways in
which their previous habits and practices (such as taking on too much at work) or general
life stress, may have added to their distress. As Roberta commented,
I mean what came home to me is obviously that my lifestyle does aggravate it,
a lot ahmm and that stress does you know play a role certainly in aggravating
premenstrual symptoms . . . if I could have stayed at home today, in bed, by
myself, you know under the duvet, I would have been a happy girl.
Women also reported letting go of trying to be in control of everything at home and
expecting the children to immediately do what they were asked and their partners to
always know what they wanted, often before they had expressed it. Letting go of these
expectations led to lessening of anger or irritation and the ability to “brush things off,” as
Alison commented:
I’ve learned to brush things off, so that’s more comfortable, also when I get
upset, little things can turn into huge things, something small may upset me,
then I’ll try to find a reason why I’m feeling so sad and crying and that escalates
into everything else in my life that’s made me sad, whereas now I don’t get
these violent crying fits, I mean they really were like screaming pain you know,
and just I just don’t get that any more I might be a little bit sad . . . but that’s it.
Awareness and repositioning of PMS
When women move away from the pathologization of distress and the position of self-sac-
rificing femininity, which led to self-castigation for not living up to impossible ideals of
perfect womanhood, they were more able to tolerate changes in ability to cope or ability to
care for others before themselves (Mauthner, 2000; O’Grady, 2005). This did not mean
that PMS was deconstructed or dismissed, however. Indeed, part of the function of this
approach was to legitimate women’s experience of premenstrual distress, while providing
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40 J.M. Ussher
a means of understanding that did not position the woman as ‘mad’ or her experience as
unimportant because it was PMS. As Kathy commented:
it was so bad and I mean my boyfriend said well you’re pre-menstrual, and I’d
say but I’m not pre-menstrual, this is really I’m feeling it you know, I’m feel-
ing this pain and I’m feeling this unhappy that I don’t want to live you know
all this type of thing, and it made me angry that he used to say that and blame
it on PMS, because I wouldn’t recognize it as real . . . and so now that I know
that people are recognizing it and doing something about it, its easier for me to
say, you know, this is something that happens, it doesn’t mean you are always
going to feel like this, its going to go away.
The process of re-authoring PMS and experiencing increased self-efficacy in relation
to their symptoms led to women rejecting the positioning of their premenstrual emotional
reactions as a ‘thing’ which is out of their control, a manifestation of monstrous femininity
for which they feel shame. Instead they positioned emotional reactions as understandable,
as something that can be recognized and contained. Women learnt to identify their own
trigger points and the limits of their tolerance, avoiding the build of frustration or anger
that erupts in an uncontrollable way premenstrually. As Tricia commented:
I don’t think the frequency of them [angry moods] happening inside me has
slowed down, but yes, I have been able to recognize them occasionally and
I have walked away and that has worked . . . there’s almost a point at which I
can control it and after a certain point, its gonna happen but if there is a grad-
ual build-up that, I can do something about it and when I do get that little bit
of warning I do and it works and every time since Margaret [the therapist]
showed me how to, yeah to relax and walk away from it.
In cases where women did still experience anger or irritation premenstrually, they
were more aware of it and able to take responsibility for it, rather than splitting it off as a
pathology which was separate from them. Thus they were able to look at the issues that
were making them angry and assess how to deal with them without losing control. If they
did lose their temper they were more able to apologize without entering into a cycle of
guilt and self-blame. As Helen told us:
I if I find myself out-bursting I’ll think immediately oh my God I’ve just done
it I have to correct it and become more conscious of it more conscious, so
where as before I wouldn’t apologize for my behavior but now I’m really
aware of it so that’s you know a real good breakthrough for me (laughs).
Care of the self
All of the women reported the effective implementation of strategies to cope with premen-
strual changes in mood, sensitivity or embodied experiences and engagement in more self-
care. They reported that this resulted in a significant reduction in their symptoms, as well
as helping them to cope if they did feel distressed premenstrually. As Lynne said:
When I’m premenstrual I try to do things that I enjoy doing, not putting so
much pressure on myself, ahmm work pressure, even things like exercise
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The Impact of a Psychological Intervention on Women’s Self-Policing 41
pressure like you know, if I promise I’m gonna do three days exercise a week
an if I’m premenstrual well I’ll think well you know blow it I’m not, I’m not
gonna do it, so I’m kinder to myself.
Or, as Nita commented, “The symptoms haven’t gone away, its just the way I am able
to cope with them is better.” Taking time out from being with others, if they needed it, was
no longer positioned as a luxury, but rather as a necessity to maintain well-being and
health. This was positive for both the woman and her family, as it resulted in the reduction
of irritation in relation to others.
This re-positioning of premenstrual anger and irritation as something that can be rec-
ognized as it begins to emerge led to strategies that acted to protect the woman and her
family, such as walking away, or learning to relax, as we see above. This allowed women
to express their feelings in a calmer way when they had cooled down, and at the same
time, served to shift women out of a position of pathology where the fecund body was to
blame. For pre-intervention the majority of women said that PMS was caused by hor-
monal factors; only one woman adopted this explanation post-intervention. The remainder
positioned their distress in the social and relational context of their lives, which gave them
a greater sense of empowerment. The premenstrual phase of the cycle was reframed as a
time when women needed to attend to their own needs and ask for support, rather than a
time when women fail or are ill. Because of this, the majority of women felt confident that
they could understand and live with their premenstrual changes without further profes-
sional intervention. The only women who stated that they would like continued therapeu-
tic support were those who felt that significant relationship problems or issues associated
with childhood sexual abuse, had been raised as part of the intervention.
Conclusion
PMS has been positioned as a psychiatric illness that warrants biomedical intervention,
functioning to position women as potentially mad or bad premenstrually, and thus as mar-
ginalized from society. What this study illustrates is that women’s premenstrual distress is
tied to cultural constructions of femininity and to relational issues. It also shows that
women can be supported in the process of contesting PMS as an embodied pathology,
allowing them to shift from a disempowering subject position, where distress is blamed on
a dysfunctional reproductive body and where premenstrual changes are split off as pathol-
ogy, to a position where distress is experienced as an understandable reaction to the cir-
cumstances of their lives. Women are then not positioned as failing or bad for being angry,
unhappy or anxious—or for sometimes feeling they need support and cannot look after
everybody else’s needs at the cost of their own. This shift in positioning can have a signif-
icant effect on women’s experience of distress, through facilitating the development of
self-care and through experiencing the fecund body as part of their subjectivity, not as an
unruly force that is other to them and feared because it is out of control. Thus pathologiza-
tion of the reproductive body is effectively contested, at the same time as women’s legiti-
mate concerns and distress are taken seriously and premenstrual change is experienced as
just that—change rather than illness.
This analysis has relevance beyond the specifics of premenstrual distress and could
equally be applied to postnatal and menopausal distress (Ussher, 2006). Indeed, interven-
tions that focus on a reduction of self-policing in the postnatal period have been found to
help women to resist pressure to emulate idealized notions of perfect motherhood and to
effectively reduce depression (Mauthner, 2000). Equally, women who reject medicalized
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42 J.M. Ussher
notions of menopause are less likely to experience midlife distress or to blame their bodies
if they do become unhappy (Hunter and O’Dea, 1997). While notions of the ‘monstrous
feminine’ tied to the reproductive body may function to marginalize women and their
experiences, women can effectively resist such practices. As a result, they are able to resist
their own marginalization.
Acknowledgements
This research was funded by a grant from the North Thames Regional Health Authority
(UK) and a University of Western Sydney Research Partnership Scheme grant, in
conjunction with FPA Health (Australia). Full ethics approval was granted by University
College London and University of Western Sydney. The interviews were conducted by
Jane Ussher and Susannah Browne. Thanks are extended to Janette Perz for discussion of
the ideas in this paper.
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About the Author
Jane M. Ussher is Professor of Women’s Health Psychology and director of the Gender
Culture and Health Research Unit, PsyHealth, at the University of Western Sydney,
Australia. She is the author of a number of books, including The Psychology of the Female
Body, Women’s Madness: Misogyny or Mental Illness?, Fantasies of Femininity: Reframing
the Boundaries of Sex, and Managing the Monstrous Feminine: Regulating the Reproduc-
tive Body. Her current research focuses on women’s sexual and reproductive health, with
particular emphasis on premenstrual experiences and gendered issues in caring.
