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  • How many people here have heard of PMS?

    有多少人聽過經前症候群 (PMS)?

  • Everybody, right?

    大家都聽過,對吧?

  • Everyone knows that women go a little crazy

    大家都知道女人在月經來之前

  • right before they get their period,

    會有點發神經,

  • that the menstrual cycle throws them onto an inevitable hormonal roller coaster

    月經週期讓她們坐上 無可避免的荷爾蒙導致的

  • of irrationality and irritability.

    不理性與易怒的雲霄飛車。

  • There's a general assumption

    有個很普遍的說法,

  • that fluctuations in reproductive hormones cause extreme emotions

    說生殖荷爾蒙波動 會造成極端的情緒,

  • and that the great majority of women are affected by this.

    而且絕大部分婦女都受此影響。

  • Well, I am here to tell you that scientific evidence says

    嗯,我在這裡告訴大家 科學證據顯示

  • neither of those assumptions is true.

    這兩個說法都不對。

  • I'm here to give you the good news about PMS.

    我要在這裡宣布 經前症候群的好消息。

  • But first, let's take a look at how firmly the idea of PMS

    但首先來看一下 經前症候群這個說法

  • is entrenched in American culture.

    有多麼深植於美國文化。

  • If you examine newspaper or magazine articles,

    如果你檢視報章雜誌的文章,

  • you'll see how widely assumed it is that everyone gets PMS.

    你就會發現大家都以為 每個人都有經前症候群。

  • In an article in the magazine Redbook titled "You: PMS Free,"

    女性雜誌《紅書》有篇文章標題為: 「妳!從經前症候群釋放吧!」

  • readers were informed that between 80 to 90 percent of women suffer from PMS.

    文章告訴讀者約有八九成的女性 為經前症候群所苦。

  • L.A. Muscle magazine warned its readers

    倫敦保健食品雜誌則警告讀者

  • that 40 to 50 percent of women suffer from PMS,

    有四到五成的婦女 為經前症候群所苦,

  • and that it plays a major role in women's mental and physical health,

    而且這還在女性的身心健康 扮演重要角色,

  • and a couple of years ago, even the Wall Street Journal

    而在幾年前,甚至華爾街日報

  • ran an article on calcium as a treatment for PMS,

    也有篇文章在談 鈣質如何治療經前症候群,

  • asking its female readers,

    並這樣問其女性讀者,

  • "Do you turn into a witch every month?"

    「妳每個月都變成巫婆嗎?」

  • From all these articles, you would think there must be a mountain of research

    有這麼多文章你可能會想, 一定有如山般鐵證

  • verifying the widespread nature of PMS.

    能驗證經前症候群的普遍性。

  • However, after five decades of research,

    然而,經過五十年的研究,

  • there's no strong consensus on the definition, the cause,

    眾人對經前症候群的 定義、起因、療法,

  • the treatment, or even the existence of PMS.

    甚至到底是否存在 都沒有強烈共識。

  • As most commonly defined by psychologists,

    心理學家最常用的定義是,

  • PMS involves negative behavioral, cognitive and physical symptoms

    經前症候群會使人 從排卵開始到月經來其間,

  • from the time of ovulation to menstruation.

    陷入負面的行為、 認知、及身體症狀,

  • But here's where it gets tricky.

    但這就是詭異的地方了。

  • Over 150 different symptoms have been used to diagnose PMS,

    已有超過 150 種不同的症狀 被拿來診斷經前症候群,

  • and here are just a few of those.

    這裡只是其中幾種。

  • Now, I want to be clear here.

    那,我要澄清一下。

  • I'm not saying women don't get some of these symptoms.

    我不是說婦女不會有這些症狀。

  • What I'm saying is that getting some of these symptoms

    我要說的是有這些症狀

  • doesn't amount to a mental disorder,

    並不等於妳精神異常,

  • and when psychologists come up with a disorder

    心理學家提出某種失調病症,

  • that's so vaguely defined,

    卻定義模糊不清,

  • the label eventually becomes meaningless.

    這樣的標籤最終會失去意義。

  • With a list of symptoms this long and wide,

    有這麼洋洋灑灑的症狀表,

  • I could have PMS, you could have PMS,

    我可能會得經前症候群, 你可能也會,

  • the guy in the third row here could have PMS,

    第三排的男生也會得經前症候群,

  • my dog could have PMS. (Laughter)

    連我的狗都會得到經前症候群。 (笑聲)

  • Some researchers said you had to have five symptoms.

    有些研究員說你得要有五種症狀,

  • Some said three.

    有些人說三種就好。

  • Other researchers said that symptoms were only meaningful

    還有些研究員說那些症狀

  • if they were highly disturbing to you,

    要在非常困擾妳時才有意義。

  • but others said minor symptoms were just as important.

    但也有人說輕微的症狀也很重要。

  • For many years, because there was no standardization

    多少年了,因為沒有統一

  • in the definition of PMS,

    定義經前症候群,

  • when psychologists tried to report prevalence rates,

    當心理學家試著報出患病率,

  • their estimates ranged from five percent of women

    他們的估計範圍是

  • to 97 percent of women,

    5% 到 97% 的婦女有這個病症,

  • so at the same time almost no one and almost everyone had PMS.

    意思是同一時間,幾乎沒有人 或幾乎所有人都有經前症候群。

  • Overall, the weaknesses in the methods of research on PMS have been considerable.

    整體來看,經前症候群的 研究方法缺陷相當多。

  • First, many studies asked women to report their symptoms retrospectively,

    第一,許多研究要求 婦女回溯她們的症狀,

  • looking to the past and relying on memory,

    靠著記憶回想過去,

  • which is known to inflate reporting of PMS

    大家都知道這個方法會大量增加 經前症候群的報告數據,

  • compared to what's called prospective reporting,

    較之於所謂的前瞻性研究,

  • which involves keeping a daily log of symptoms

    要受試者每天記錄症狀

  • for at least two months in a row.

    至少連續兩個月。

  • Many studies also exclusively focused on white, middle-class women,

    許多研究也只專注在 白人中產階級婦女,

  • which makes it problematic to apply study findings to all women.

    如果將研究結果應用在 全部婦女會成為問題。

  • We know there's a strong cultural component to the belief in PMS

    我們知道相信經前症候群與否 有很強的文化要素,

  • because it's nearly unheard of outside of Western nations.

    因為這在西方國家以外 幾乎是聞所未聞。

  • Third, many studies failed to use control groups.

    第三,許多研究沒有設控制組。

  • If we want to understand the specific characteristics

    如果我們想要瞭解

  • of women who have PMS,

    有經前症候群婦女的特性,

  • we need to be able to compare them to women who don't have PMS.

    我們必須要將她們與 沒有經前症候群的女性比較。

  • And finally, many different types of questionnaires were used

    最後是,使用太多不同型態的問卷

  • to diagnose PMS, focusing on different symptoms,

    來診斷經前症候群, 專注在不同的症狀,

  • symptom duration and severity.

    症狀持續多久及多嚴重。

  • To do reliable research on any condition,

    要對任何病症做出可靠的研究,

  • scientists must agree on the specific characteristics

    科學家必須先商定

  • that make up that condition

    會造成此病症的特性,

  • so they're all talking about the same thing,

    這樣大家見解才會一致,

  • and with PMS, this has not been the case.

    但是對經前症候群 卻不是這樣研究的。

  • However, in 1994,

    然而,在 1994 年

  • the Diagnostic and Statistical Manual of Mental Disorders,

    精神疾病診斷與統計手冊,

  • known as the DSM, thankfully --

    俗稱 DSM,還好這麼短——

  • it's also the manual for mental health professionals --

    這也是身心科專家的手冊——

  • they redefined PMS as PMDD,

    他們重新定義 PMS 成 PMDD,

  • Premenstrual Dysphoric Disorder.

    經前不悅症。

  • And dysphoria refers to a feeling of agitation or unease.

    不悅指的是煩躁不安的感覺。

  • And according to these new DSM guidelines,

    根據這些新的經前不悅症準則,

  • in most menstrual cycles in the last year,

    在過去一年大部分的月經週期中,

  • at least five of 11 possible symptoms

    至少有五種 11 個可能出現的症狀,

  • must appear in the week before menstruation starts;

    在月經來潮前一星期內出現;

  • the symptoms must improve once menstruation has begun;

    這些症狀在月經來潮後就改善;

  • and the symptoms must be absent the week after menstruation has ended.

    而且這些症狀要在 月經結束一週內消失。

  • One of these symptoms must come from this list of four:

    一定要有下列四種症狀之一:

  • marked mood swings, irritability, anxiety, or depression.

    顯著的情緒起伏、 易怒、焦慮或憂慮。

  • The other symptoms could come from the first slide

    其他的症狀則可能是 第一張幻燈片

  • or from those on the second slide,

    或第二張幻燈片所列出的,

  • including symptoms like feeling out of control

    包括失控的感覺,

  • and changes in sleep or appetite.

    睡眠或食慾改變。

  • The DSM also required now that the symptoms

    經前不悅症還必須有

  • should be associated with clinically significant distress --

    具臨床意義的明顯困擾——

  • there should be some kind of disturbance in work

    對工作、學校或社交

  • or school or social relationships --

    產生一定程度的影響——

  • and that symptoms and symptom severity should now be documented

    出現的症狀及其嚴重性 必須記錄下來,

  • by keeping a daily log for at least two cycles in a row.

    至少連續兩個週期每天做記錄。

  • And finally, the DSM required that the emotional disturbance

    最後,經前不悅症的情緒困擾,

  • should be more than simply an exacerbation of an already existing disorder.

    其嚴重性應大於 原有失調的放大效應。

  • So scientifically speaking, this is an improvement.

    所以從科學角度說, 這是很大的進步。

  • We now have a limited number of symptoms,

    我們現在得到有限數量的症狀,

  • and a high impact on functioning that's required,

    要對生活功能產生強烈衝擊,

  • and the reporting and timing of symptoms have both become very specific.

    而且對症狀的描述 及發生時間講得很明確。

  • Well, using this criteria

    嗯,使用這個標準

  • and looking at most recent studies,

    並看一下最近的研究,

  • we see that on average,

    我們看到平均

  • three to eight percent of women suffer from PMDD.

    有百分之三到八的女性 為經前不悅症所苦。

  • Not all women, not most women,

    不再說是所有的女性, 多數的女性,

  • not the majority of women, not even a lot of women:

    也不是大部分的女性, 更不是很多女性:

  • three to eight percent.

    是百分之三到八。

  • For everyone else, variables like stressful events or happy occasions

    對其它女性,變因像是 壓力很大的事件或開心的場合,

  • or even day of the week

    甚至今天是星期幾

  • are more powerful predictors of mood than time of the month,

    都比月經更能預測情緒,

  • and this is the information the scientific community has had

    而這是自 1990 年代開始 科學界就有的資料。

  • since the 1990s.

    2002 年,我與幾個同事 發表了一篇論文

  • In 2002, my colleagues and I published an article

    講述經前症候群 與經前不悅症的研究,

  • describing the PMS and PMDD research,

    還有幾篇類似的論文 也發表在心理學期刊上。

  • and several similar articles have appeared in psychology journals.

    問題是,為什麼這樣的資訊 還沒有流入大眾?

  • The questions is, why hasn't this information trickled down to the public?

    為什麼這些迷思依然存在?

  • Why do these myths persist?

    嗯,顯然女性長時間 從書籍、電視、電影及網路

  • Well, certainly the onslaught of messages that women receive

    接收到的一波波消息, 都說每個人都有經前症候群,

  • from books, TV, movies, the Internet, that everyone gets PMS

    已經說服她們這是事實。

  • go a long way in convincing them it must be true.

    研究人員告訴我們女性愈相信 每個人都有經前症候群的說法,

  • Research tells us that the more a woman believes that everyone gets PMS,

    她就愈有可能錯誤地說她自己有。

  • the more likely she is to erroneously report that she has it.

    我解釋一下我說「錯誤」的意思。

  • Let me tell you what I mean by "erroneously."

    你可能問她,妳有經前症候群嗎?

  • You might ask her, "Do you have PMS?"

    她說有,

  • and she says yes,

    但之後,在你要她每天記錄

  • but then, when you have her keep a daily log

    精神症狀兩個月後,

  • of psychological symptoms for two months,

    她的症狀與月經找不到關連性。

  • no correlation is found between her symptoms

    另一個經前症候群迷思 持久不衰的理由

  • and time of the month.

    與狹隘的女性角色範圍有關。

  • Another reason for the persistence of the PMS myth

    女性主義心理學家 如喬安克萊斯勒提出,

  • has to do with the narrow boundaries of the feminine role.

    把自己貼上經前症候群的標籤,

  • Feminist psychologists like Joan Chrisler

    讓女性能表達原本會被 視為不嫻淑的情緒。

  • have suggested that taking on the label of PMS

    幾乎放諸四海皆準的好女人定義

  • allows women to express emotions that would otherwise be considered unladylike.

    是快樂、慈愛、對人充滿愛心,

  • The near universal definition of a good woman

    並且對這樣的角色很滿足。

  • is one who is happy, loving, caring for others,

    經前症候群已經成為 能生氣、抱怨、煩躁,

  • and taking great satisfaction from that role.

    卻不會失去好女人頭銜的同意書。

  • Well, PMS has become a permission slip to be angry, complain, be irritated,

    我們知道女性的環境中有很多變數

  • without losing the title of good woman.

    比荷爾蒙更容易讓她生氣,

  • We know that the variables in a woman's environment

    但是當她將怒氣歸咎於荷爾蒙,

  • are much more likely to cause her to be angry than her hormones,

    她就免於責任,也免除了責難。

  • but when she attributes anger to hormones,

    喔,她平常不是那樣的。 她控制不了。

  • she's absolved of responsibility or criticism.

    儘管這可以當作有用的工具, 實際上卻否定了女性的情緒。

  • "Oh, that's not who she is. It's out of her control."

    在大家對女性的怒氣

  • And while this can be a useful tool, it serves to invalidate women's emotions.

    用「喔,大姨媽來了」 這樣的想法來回應時,

  • When people respond to a woman's anger

    她被人認真看待 或有效改變的機會就大受限制。

  • with the thought, "Oh, it's just that time of the month,"

    那麼還有誰會從 經前症候群迷思中得利?

  • her ability to be taken seriously or effect change is severely limited.

    我可以告訴你們治療經前症候群

  • So who else benefits from the myth of PMS?

    已成為有利可圖、蓬勃發展的行業。

  • Well, I can tell you that treating PMS

    亞馬遜網站最近放了超過 1,900 本治療經前症候群的書。

  • has become a profitable, thriving industry.

    在谷歌上隨便找找就能找到

  • Amazon.com currently offers over 1,900 books on PMS treatment.

    一籮筐的診所、專討或研討會。

  • A quick Google search will bring up a cornucopia

    聲譽良好的醫療資源網站

  • of clinics, workshops and seminars.

    如網路醫師或梅奥醫院 將經前症候群列為已知的病症。

  • Reputable Internet sources of medical information

    這並不是已知的病症, 但他們將其列為之一。

  • like WebMD or the Mayo Clinic list PMS as a known disorder.

    他們也列出醫師開出的治療藥物,

  • It's not a known disorder, but they list it.

    如抗憂鬱劑或荷爾蒙。

  • And they also list the medications that physicians have prescribed to treat it,

    但很有意思的是,兩個網站都說

  • like anti-depressants or hormones.

    治療經前症候群的藥物 成效因不同女人而異。

  • Interestingly, though, both websites say that the success of medication

    這沒道理。

  • in treating PMS symptoms vary from woman to woman.

    如果你得了某種很明確的病症 起因也很明確,

  • Well, that doesn't make sense.

    經前症候群就被歸為此類,

  • If you've got a distinct disorder with a distinct cause,

    那麼應該會在大部分 女性身上看到治療成效。

  • which PMS is supposed to be,

    但是這些治療藥物並非如此,

  • then the treatment should bring improvement for a great number of women.

    美國食品藥物管理局的法規說 某種藥物要視為有效,

  • This has not been the case with these treatments,

    必須在大部分的目標族群身上

  • and FDA regulations say that for a drug to be deemed effective,

    看到有臨床意義的改善。

  • a large portion of the target population

    我們還沒有在這些 所謂的治療法上看到這點。

  • should see clinically significant improvement.

    然而,延續此項迷思,

  • So we have not had that at all with these so-called treatments.

    即經前症候群是常見、 可治療的精神病症,

  • However, the financial gain of perpetuating the myth

    所得到的經濟利益相當可觀。

  • that PMS is a common mental disorder

    如果婦女接受藥物 如抗憂鬱劑或荷爾蒙,

  • and is treatable is quite substantial.

    醫療計畫常規要求她們 必須每三個月回診一次。

  • When women are prescribed drugs like anti-depressants or hormones,

    這可是相當大量的就醫次數。

  • medical protocol requires that they have physician follow-up every three months.

    製藥公司賺進數不清的利潤,

  • That's a lot of doctor visits.

    就因為女人接受她們必須

  • Pharmaceutical companies reap untold profits

    在生育年齡吃處方藥的說法。

  • when women are convinced they should take a prescribed medication

    非處方藥物如止經痛藥 「美多」甚至宣稱

  • for all of their child-bearing lives.

    可以治療經前症候群症狀, 如緊張及易怒,

  • Over-the-counter drugs like Midol

    即使藥物成分只有利尿劑、止痛藥

  • even claim to treat PMS symptoms like tension and irritability,

    及咖啡因。

  • even though they only contain a diuretic, a pain reliever

    那麼,我沒立場爭論 咖啡因的神奇力量,

  • and caffeine.

    但我也不認為咖啡因 有減輕緊張的效用。

  • Now, far be it from me to argue with the magical powers of caffeine,

    自 2002 年起,美多開始 銷售「婷美多」給青少女。

  • but I don't think reducing tension is one of them.

    他們早早把目標對準年輕少女,

  • Since 2002, Midol has marketed a Teen Midol to adolescents.

    說服她們每個人都會得經前症候群, 而且這會讓妳變成大怪物,

  • They are aiming at young girls early,

    但是等一下!妳還有救的!

  • to convince them that everyone gets PMS and that it will make you a monster,

    吃下美多妳就變回人了!

  • but wait, there's something you can do about it:

    2013 年,美多的銷貨收入 為四千八百萬美金。

  • Take Midol and you will be a human being again.

    所以延續經前症候群迷思 除了成為某些人吸金的工具外,

  • In 2013, Midol took in 48 million dollars in sales revenue.

    還為婦女帶來嚴重的不良後果。

  • So while perpetuating the myth of PMS has been lucrative for some,

    第一,它使女性的生育健康醫療化。

  • it comes with some serious adverse consequences for women.

    醫界有著很長的歷史 將女性的生育過程

  • First, it contributes to the medicalization

    視為疾病、需要治療的概念,

  • of women's reproductive health.

    而這已造成許多花費, 包括過多的剖腹產、

  • The medical field has a long history of conceptualizing

    子宮切除術、及開出荷爾蒙治療藥,

  • women's reproductive processes as illnesses that require treatment,

    而藥物的傷害大於增進婦女健康。

  • and this has come at many costs, including excessive Cesarean deliveries,

    第二,經前症候群迷思也是造成女性

  • hysterectomies and prescribed hormone treatments

    易怒及過度情緒化的刻板印象原因。

  • that have harmed rather than enhanced women's health.

    一旦月經週期被形容為 荷爾蒙雲霄飛車,

  • Second, the PMS myth also contributes to the stereotype of women

    把女性變成氣呼呼的野獸,

  • as irrational and overemotional.

    我們就很容易質疑女性的能力。

  • When the menstrual cycle is described as a hormonal roller coaster

    婦女在工作場合的地位 已有極大的進步,

  • that turns women into angry beasts,

    但是仍然只有極少數的女性

  • it becomes easy to question the competence of all women.

    處在政府或企業的高層職位,

  • Women have made tremendous strides in the workforce,

    而且每次我們考慮什麼樣的人 可稱為好的執行長或參議員,

  • but still there's a minuscule number of women at the highest echelons

    具有理性、穩健、能力等條件的人

  • of fields like government or business,

    就會在腦中浮現,

  • and when we think about who makes for a good CEO or senator,

    在我們的文化,那些條件 聽起來更符合男人而非女人,

  • someone who has qualities like rationality, steadiness, competence

    經前症候群迷思正是助長的原因。

  • come to mind,

    心理學家知道男人與女人的情緒

  • and in our culture, that sounds more like a man than a woman,

    更趨相似而非相異。

  • and the PMS myth contributes to that.

    一項研究追蹤男人與女人 四到六個月,

  • Psychologists know that the moods of men and women

    發現兩性經歷心情起伏的次數

  • are more similar than different.

    及其嚴重性並沒有不同。

  • One study followed men and women for four to six months

    最後,經前症候群迷思 不讓女性處理

  • and found that the number of mood swings they experienced

    造成他們心煩意亂的真正原因:

  • and the severity of those mood swings were no different.

    個人因素如 人際關係品質或工作環境,

  • And finally, the PMS myth keeps women from dealing

    或社會因素如種族歧視、 性別歧視或貧窮的磨難,

  • with the actual issues causing them emotional upset.

    都與每天的情緒有很大的關係。

  • Individual issues like quality of relationship or work conditions

    以經前症候群當藉口 逃避情緒問題,

  • or societal issues like racism or sexism or the daily grind of poverty

    只是讓女人更難瞭解 她們負面情緒的來源,

  • are all strongly related to daily mood.

    同時也拿走讓她們 以行動來改變情緒的機會。

  • Sweeping emotions under the rug of PMS

    所以經前症候群的好消息

  • keeps women from understanding the source of their negative emotions,

    是有些女人的確因 月經週期而有某些症狀,

  • but it also takes away the opportunity to take any action to change them.

    但大部分的女人並不 因此而得了神經病。

  • So the good news about PMS

    她們照常工作、上學、照顧家庭,

  • is that while some women get some symptoms because of the menstrual cycle,

    以正常的水準行使職責。

  • the great majority don't get a mental disorder.

    我們知道男人與女人的情緒及心情

  • They go to work or school, take care of their families,

    更趨相似而非相異,