PERSPECTIVE ON PMS : You Haven’t Come Very Far, Baby : Women should be wary when psychiatrists want to label physical symptoms as a new mental disorder.

The issue of day care has scuttled two female candidates for attorney general, and the President has solved this problem temporarily by finding a woman who has no children. But watch out; soon the only women who will achieve high office will be those who don’t have a uterus. This is the only way they will be able to avoid charges of irrationality due to “premenstrual syndrome,” which the American Psychiatric Assn. is about to make a certifiable mental disorder. (Of course, when women stop menstruating they suffer from menopausal deficiency disorder, which also makes them crazy, but that’s another story.)

PMS isn’t just a cute label for some women’s discomfort or a funny subject for tampon ads and sitcoms. It’s big business, and its pernicious effects are apparent in the story behind the manufacture of what psychiatrists will call “premenstrual dysphoric disorder.”

The “Diagnostic and Statistical Manual of Mental Disorders,” the Bible of psychiatry, contains a list of mental disorders that are compensable by insurance companies. As the territory of psychiatry and clinical psychology has expanded, so has the number of treatable problems. In 1968, the manual contained 60 categories of mental illness; in 1987, it had more than 300--not only serious disorders such as schizophrenia, but also normal problems for which people seek help, such as tobacco dependence and sexual complaints.

Now, there’s nothing wrong with that, as long as we understand that most definitions of mental disorder are a matter of subjective clinical consensus, not science. As attitudes changed, psychiatrists voted out biased old “disorders” such as penis envy, nymphomania and homosexuality. And, they have voted in disorders that reflect modern biases, such as “inhibited sexual desire.”

Recently, a task force working on a new edition of the DSM has recommended the inclusion of “premenstrual dysphoric disorder.” Many scientists are appalled at this and hope the APA board will overturn the recommendation. Their reasons are simple: the scholarly evidence for the diagnosis is lousy and the social implications for women are dangerous.

Psychiatrists get very huffy about anyone who suggests that PMDD is just PMS in fancy dress. PMDD, they say, is meant to describe only the tiny percentage of women who have severe physical and emotional symptoms associated with menstruation. But if that’s so, why should a problem with menstruation be included in a manual of mental disorders? Thyroid abnormalities and other physical problems cause mood and behavior changes too, but we don’t regard these changes as a psychiatric illness. There is no diagnosis, say, for “chronic back pain depressive disorder.”

The list of criteria for diagnosing PMDD gives the game away. A woman must have five of these symptoms: mood swings; anger or irritability; anxiety or tension; depressed mood or self-deprecating thoughts; decreased interest in usual activities; fatigue; change in appetite; sleeplessness or sleepiness; physical symptoms such as breast tenderness or swelling, headaches, muscle pain, bloating and weight gain (those latter symptoms are all normal aspects of menstruation, of course.) How does this list differ from the popular concept of PMS? (Not at all.) What is to prevent psychiatrists from overdiagnosing this “disorder,” as they already do? Where is the stipulation that this diagnosis must depend on measuring a woman’s hormone levels, to separate a woman with PMDD from one whose problem is depression?

Moreover, the idea that these symptoms constitute a disorder at all overlooks these research findings:

* When men keep dairies of their moods and symptoms (headaches, insomnia, muscle pain, fatigue and irritability), their symptoms do not differ, on the average, from women’s. Actually, men are somewhat more irritable all through the month. So why are women’s mood changes a “disorder,” while men’s are “normal ups and downs?”

* In spite of 50 years of efforts to find negative effects, research consistently shows that the menstrual cycle has no effect on mental abilities, competence or academic performance. In contrast, high testosterone is associated with violence, drug abuse and impulsive behavior, yet psychiatrists have not felt it necessary to invent “hypertestosterone aggression disorder.”

* Whatever PMS or PMDD are, there is no treatment for them. Controlled studies find that progesterone, most commonly prescribed, is no more effective than a placebo. But “cures” and medical centers are a thriving business. The diagnosis is quick, easy and compensable. Doctors and drug companies will make money off it.

Many women embrace the language of PMS because it validates the normal changes of the menstrual cycle and--let’s be candid--because it gives them an excuse to blow off steam at least once a month. (The comparable excuse for men is drinking.) But women pay a big price for buying PMS. The mere rumor that Michael Dukakis had been treated for depression was held against him; imagine the fun the press would have or the weapon an employer would have with a woman who had been treated for “premenstrual dysphoric disorder.”

Women are already reporting that their legitimate complaints in the workplace and the home are being ridiculed as evidence of “PMS.” In bestowing its self-serving approval to this label, the psychiatric establishment feeds the prejudice that women’s hormones, but not men’s, are a cause of mental illness. That’s just ancient superstition in pompous new jargon.