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Diagnosing the Body: Navigating the Mental Health System with PMDD


The first time I end up in the psychiatric ward at the age of 16, I swear it'll be the only time. It happens after confessing to my mother that I'd rather die than go back to school. Over-dramatic, perhaps, if she hadn't found me stashing away the pills.


In the juvenile ward in Nowhere, USA, we do talk therapy and art therapy. The doctors test out different combinations of meds, and I end up feeling dazed, but no longer suicidal. It's enough to convince them that it's just depression.


Just depression. As if a week of suicidal intent is like a cold or a fever. Just a bit of coughing. Just a minor infection.


Just a touch of not wanting to live.


When I get my period on the ward, I spend the entire day trying to hide the blood. Soon enough, they release me back to my parents with an SSRI prescription and orders for weekly follow-ups with a therapist. Everything's fine, except for the monthly flow that I can never seem to deal with properly. As far as I know, though, that's not anything out of the ordinary.


This will turn out to be important late


 

In 2023, nearly 30% of Americans reported having been diagnosed with depression. Together with Bipolar, depression is a mood disorder, the second most common diagnosis for people suffering from mental health issues after anxiety.


But mood disorders are nothing new. As early as 500 BC, the ancient Greeks recorded symptoms of "melancholia", a sort of long-lasting despondency. Even older is the distinctly feminine illness of "hysteria", described by the ancient Egyptians with symptoms similar to a panic attack.


For the ancients, these diseases were thought to originate in the body - through imbalances of the humours, or the movements of a wayward uterus. Nowadays, psychologists know better; mental illness is a result of disordered thinking, imbalanced brain chemicals, maladapted mechanisms for coping with trauma.


But perhaps things are more complicated still.


Over the next five years, I'm sectioned three more times - sometimes closer to and sometimes further from attempted suicide. Every time, the doctors assign new pills to quell the storm. But the meds never seem to work for long. Within three weeks of a new dose, I'm back to sobbing in my therapist's office.


The fourth time I find myself in the hospital, the doctor looks over my paperwork, notes the persistence of my symptoms, the turbulence in my relationships due to my emotional instability. Even then, he doesn't notice the pattern that dictates my incandescent anger, the despair.

"I think you might benefit from a different kind of therapy," he tells me. He has a suspicion that the tide of my emotions, the fleeting swells, and horrific crashes, aren't entirely due to depression, or even bipolar. This time, I leave the ward with an appointment for Dialectical Behaviour therapy (DBT) - a type of cognitive therapy developed for people with personality disorders - along with a new diagnosis:



 

Unlike mood disorders, personality disorders are relative newcomers to the field of mental health, arising alongside more scientific analyses of both personality and mental disorders through the early 20th century. The Diagnostic and Statistical Manual of Mental Health (DSM) - the main tool used to diagnose mental illnesses - defines personality disorders as patterns of thoughts and actions which "deviate markedly from the expectations of the individual's culture".


Perhaps because they are so culturally bound, diagnoses of personality disorders are also far more likely to stigmatise those who seek help for them, as previously discussed on ITM. This makes it difficult for sufferers to get the support they need.


In some ways, the diagnosis of a personality disorder can feel terminal. This isn't an illness that can be confined to one part of your life, compartmentalised and hidden away and maybe cured. The problem, according to everyone you interact with, is your entire personality.


The DBT doesn't last very long. A few weeks in, I'm frustrated by the group lessons, the focus on identifying triggers that don't seem to exist, at least not consistently.


I end up moving half-way across the world to the tiny country of Malta, cast-away in the middle of the Mediterranean. My new psychiatrist reaffirms my BPD diagnosis, but I'm starting to suspect there's something terribly wrong, not just with my psyche, but with my entire body.


Every month, there are two weeks when I’m fine - when my triggers aren't triggers, when I am calm, controlled, even content. But then there are the other two weeks, when depression and rage and the raw angry hurt sweep over me like a wave. These dark days always come just before my period.


But I'm not able to connect those dots, not yet.


 

The connection between "mind" and "body", when it comes to mental health, is far from fully understood. When it comes to diagnoses, both psychiatrists and psychologists focus primarily on thoughts, feelings, and self-report. After all, there's no blood test that can tell a doctor you have depression - even though there's good evidence that the brains of depressed people fire differently.


But considering how intimately psychiatrists know that small changes in brain chemistry can create huge differences in feelings and behaviour, why isn't more done to look at mental health as part of a holistic approach? One that considers the mind and body to be one, instead of two different elements with separate diagnostics, separate pathologies, divided experiences?


 

Three years after I leave Malta, I’m sitting through an intake session for a new round of therapy in the UK. The nurse going over my history takes in the litany of meds and sectionings, as well as my other medical experiences - the overly heavy monthly flows and debilitating cramps.


"Have you considered you might have PMDD?" she asks me. Premenstrual Dysphoric Disorder (PMDD), she means: a particularly horrific form of premenstrual syndrome, which can make you feel like a different person in the latter half of your cycle.


Over the next few months, I record my moods religiously, tracing highs and lows over the ovulation and menstruation predictions of a period-tracking app. The pattern of peaks and troughs, the swells and ebbs, makes my diagnosis startlingly clear. It’s only taken two decades to discover it.


I have PMDD.


PMDD lies in that strange, unexplored space between mind and body. On one hand, caused by shifting hormones during the latter half of the menstrual cycle, it is understood as a sort of hormonal disorder. On the other hand, its diagnostic criteria are included in the DSM, where it is classified as a depressive disorder.


My mind rebels, but the cause lies deep within my body, within my ovaries and the chemicals that run my reproductive system. It is my body that is imbalanced but my mind that suffers.


It’s hard not to regret the decades lost to misdiagnosis and stigma. But the knowledge that my pain has a cause, that my despair is a result of identifiable processes, makes it easier to deal with. Now that I know where the storms are coming from (and when), I can try to ride the waves.



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