A growing number of experts are arguing that—as far as mental health is concerned—pre-menstrual syndrome is a culture-bound syndrome, meaning that it's diagnosis is based on societal expectations of how women should behave and feel, instead of biological reasoning.

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) was published over the weekend, but the "bible" of mental health has become increasingly controversial. It describes and categorizes mental illnesses by their symptoms to be used as a guide for diagnosis. But one criticism, according leading mental health experts, is that those symptoms are "cultural constructions, not global certainties"—meaning that "crazy" in one place could be "normal" in another.

Some disorders that fall under the umbrella of potentially culture-bound rather than biological are depression and PMS, wherein "the patient displays symptoms that are recognized as indicating a particular illness only by other members of that patient's cultural group."


In 1987, Thomas S Johnson claimed that the symptoms were an expression of "conflicting societal expectations" on women. In 2012, a meta-analysis of published research failed to find evidence that negative mood correlates to the pre-menstrual phase of the menstrual cycle. And earlier this year, a qualitative study found that a "cognitive reframing" of the symptoms could reduce self-reported pre-menstrual distress.

Of course, that doesn't mean that depression or PMS aren't real illnesses with real symptoms for those suffering from them, but a "diagnostic inflation" might be at play, with women being told that they have PMS as a sort of convenient excuse for their moods, which aren't particularly agreeable. It brings an old Gloria Steinem quote to mind:


Are mental illnesses such as PMS and depression culturally determined? [Guardian]