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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

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

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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