ABSTRACT

The acceptance by the medical profession of an association between the menstrual cycle and the psychological or physical state of women is centuries old, as is the medical management of the resultant “symptoms”. Both Plato and Hippocrates documented the deleterious influence of the “wandering womb”, recommending “passion and love” followed by pregnancy, as the cure for “all manner of diseases” the womb “provoked” (Veith, 1964, p.7). In the nineteenth century, menstruation became the more specific focus of attention, being described by one commentator as “the moral and physical barometer of the female constitution” (Burrows, 1828, p.147), and by others as a cause of “moral and physical derangement” (Maudsley, 1873, p.88). This connection between menstruation and madness was first reified within the medical and psychological literature 1931, with the early descriptions of “premenstrual tension” (PMT): a condition manifested by a combination of physical and psychological symptoms occurring in the days immediately prior to menstruation, which ceased at the onset of menses. Robert Frank,

the gynaecologist commonly credited with establishing the existence of PMT, attributed the symptomatology to accumulations of “the female sex hormone”, oestrogen (Frank, 1931), and, as a consequence, advocated medical intervention. Contemporaneously, the feminist psychoanalyst Karen Horney described “premenstrual tension” as a psychological response to the anxieties and fantasies associated with pregnancy, as well as the frustrations caused by the cultural restrictions on the expression of female sexuality, with symptoms triggered by “the physiological processes of preparation for pregnancy” (Horney, 1931, p.7). Whereas Frank viewed premenstrual tension as a dysfunction, Horney asserted that it was not a pathological process, because the fluctuations in mood, as well as the anxiety, irritability, and “intensities of feelings of self deprecation to the point of pronounced feelings of oppression and of being severely depressed” occurred in “otherwise healthy women” (Horney, 1931, p.2).