Psychic States In Menstruation





One does not need to be a physician to be familiar with the curious

psychic states which develop or are accentuated during the menstrual

period. Practically all the peculiarities of the individual are

emphasized at this time and if there are any special neurotic

conditions or psychic anomalies these become quite marked. All the

dreads, for instance, are more noticeable at this time. Women who at

all times feel uncomfortable on looking down from a height are likely

at this time to be quite overcome by fear and be unable to approach

any position from which they might look down for a distance. Women who

are afraid of horses, yet conquer their dread sufficiently to ride

behind them, cannot do so, or only with great difficulty, during the

menstrual period, and the same is true of the dread of cats or other

animals. Misophobia, the dread of dirt, may be particularly emphasized

at this time and servants are puzzled as to what has come over a woman

who was not so punctilious in the matter a short time before.





Irritability.--Dr. Charcot, the famous French nerve specialist, used

to say that for a day or two before menstruation and during the first

day or two of their period many women were not quite responsible. This

is not merely an exaggeration of French contempt for women, for

Moebius, the distinguished German neurologist, insisted that there is a

certain physiological mental disturbance with distinct hampering of

the faculty of judgment (Schwachsinn) normally associated with

menstruation.



Few physiologists or gynecologists agree with these extreme views, but

there is no doubt that many of the troubles which business men

experience with women in their employ begin with hasty words spoken at

these periods when the real reason for the irritability is not known.

The consciousness of this on the part of some women saves them from

much undesirable friction by making them more careful at these

periods. Many a domestic misunderstanding begins at these times and is

unfortunately allowed to continue because the real reason for it--the

instability of disposition due to menstruation--is not recognized.





Lack of Inhibition.--There is no doubt that, except in women of the

most stable physical and psychic character, a notable lack of

inhibition characterizes all their actions at this time. To think that

this is universal, however, would be a mistake. Healthy women deeply

occupied with something they like often pass through menstruation

absolutely undisturbed, and this is particularly true of the mothers

of families. In spite of its exaggeration, it is well to keep the

great French specialist's expression in mind, for it helps to explain

many things that produce much suffering in the world. This is

particularly true now that women are working more and more out of

their homes at occupations which often make strenuous calls on them

just at periods of the month when they should have more rest than

usual. The consequence often is the development of a highly neurotic

condition in which psychic symptoms are likely to be prominent

as well as a tendency to exaggerate the significance of their feelings

which is disturbing to the patient and may even disturb the physician.





Exaggeration of Sensitiveness.--The most striking feature of this is

the tendency to exaggerate the meaning of physical symptoms which they

have often borne with for a good while without much inconvenience, but

which now appeal to them as of serious significance. Any uncomfortable

feeling is likely to be dwelt on to such an extent as to be called an

unbearable ache or even an excruciating pain, and the patient is prone

to connect it with some serious pathological process in the region in

which it is felt. If a woman has been reading about some special

ailment, or, above all, has been listening to the tale, usually

neither plain nor unvarnished, of a friend's medical woes, she is

almost sure to think that there must be something seriously wrong with

herself. Many a supposed chronic indigestion had its origin in nothing

more than the uncomfortable feelings in the stomach region during

menstruation, which call attention to that organ and then, by morbid

introspection, lead to the exaggeration of various sensations that

have always been present but have hitherto been disregarded.



It is a good rule to neglect symptoms that develop during the

menstrual period and not to treat them directly until it is plainly

seen that they persist afterwards; for symptomatic treatment at this

time will cause an over-attention to the condition. And we should be

careful not to suggest to a woman at this time that her symptoms may

be due to some pathological condition in an important organ. Such a

suggestion will almost surely be accepted seriously and dwelt on so

much as to become an auto-suggestion that may lead to the disturbance

of the function of the organ in question because of the surveillance

over it. The diagnosis must be put off until menstruation is over in

order that the exaggeration of this period may be eliminated. If this

were more commonly done and if women were advised to counteract their

feelings at this time as far as possible by occupations of interest to

them, there would be much less need of medication. As between rest and

strenuous work during the menstrual period, work is probably always

the better. Rest with nothing to do emphasizes morbid introspection to

such a degree as to make even ordinary feelings unbearable.





Symptomatic Conditions.--It is interesting to note how often

affections that are always present give symptoms only during the

menstrual period or just before it. Many women, however, suffer

considerably about the time of the menstrual period from an extremely

tired, painful condition of the leg below the knee which is really due

to flatfoot. At other times it gives them little annoyance. Old

dislocations and sprains are particularly likely to give bother at

this time. All the occupation pains and aches are emphasized.

Tiredness becomes a torment. This extreme over-sensitiveness extends

to physical ills of all kinds, even those that are trivial. For

instance, corns and bunions become almost unbearable, especially if

there is any change of the weather with moisture in the air about the

time of menstruation. Teeth become sensitive and often will ache when

there is little that the dentist can find the matter with them. Women

are often suffering from teeth that are supposed to be quite

intractable because of over-sensitiveness, while in reality it is only

at these certain times that the over-sensitiveness is present.







Over-reactions.--Even habitual actions which are accomplished without

much difficulty at other times are likely to be a source of annoyance

about this period. If a young woman has to call out figures or read

off lists of names, she soon becomes hoarse, her voice becomes husky

and it requires more effort to accomplish her work than at other

times. Complaint of sore throat is common about this time, and if

there have been any recent changes in the weather this is almost sure

to be a premonitory symptom of menstruation. Singers and elocutionists

are likely to find their occupations particularly trying at this time

and actresses are seldom without considerable physical discomfort that

makes playing difficult and unsatisfactory. This happens in all

occupations requiring frequently repeated use of particular muscles.

Piano-players and typewriters find that their fingers become sensitive

at this time. This sensitiveness of the ends of the fingers may become

so marked as to prevent these usual occupations, or at least may

require their limitation.





Physical Basis of Psychic States.--The physical basis of these

troubles is probably more responsible for them than has been thought,

though the mental state renders the individual more susceptible to

annoyances of any and every kind. Careful weighing seems to show that

there is a gain in weight amounting sometimes to three to five pounds

toward the end of the menstrual month. This is accompanied by a sense

of fullness that is perhaps an actual plethora, as if nature were

manufacturing a superabundance of blood in anticipation of the loss.

This produces a systemic hyperemia. It is well known that hyperemic

areas are more sensitive than tissues in ordinary condition and this

seems to be the case in menstrual life. This renders the nervous

system more active and irritable and the nerve endings more sensitive.

With the menstrual loss this physical condition is relieved and then

there is a return to normal with a loss of weight only partly due to

the actual blood loss and somewhat to increased excretion in

perspiration, in transpiration through the lungs and through all the

emunctories.





Treatment--To know that these psychic disturbances are likely to occur

at the time of menstruation is to be prepared for them so as to lessen

their effect upon one's self and others. They are much relieved by

this frank recognition and the patient understands that with the

betterment of the psychic condition by such reassurance the physical

symptoms are lessened. Many a woman gives up her occupation at such

times who would be much better if she bravely clung to it and resisted

the temptation to be moodily occupied with her condition. Above all,

she needs to be in the air. Oxidizing processes within the body are

slower and while much exercise is not beneficial and may be often

harmful, riding in the air, sitting in the air, above all, sleeping

where there is an abundance of fresh air is all-important. Every form

of exertion will be reflected in increased irritability. Shopping,

balls and parties will disturb the woman's mental equilibrium and make

it more difficult for her to stand whatever physical discomforts she

may have, and also make it hard for her to pursue her ordinary

occupation if this is somewhat exacting. Even these, however, must not

be given up if the sacrifice involves the throwing of the patient back

on self and increases introspection. Diversion of mind and

temporizing with symptoms are the basis of therapy at the menstrual period.





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