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在座有多少人聽過經前症候群(PMS)?大家都聽過,對嗎?大家都知道女性在月經來潮前會有點情緒不穩,月經週期使她們無法避免地坐上荷爾蒙雲霄飛車,導致不理性和易怒。有個普遍的說法是生殖激素的波動將造成極端情緒,大多數女性都因此受到影響。我在這裡告訴大家,科學證據顯示這兩種說法都不正確,我將帶給你們關於經前症候群的好消息,但首先我們看一下關於經前症候群的想法多麼深植於美國文化。如果你查閱報章雜誌的文章,你將發現人們認為每位女性都有經前症候群的想法多麼普遍。在《Redbook》雜誌中有篇標題為「妳!擺脫經前症候群吧!」的文章寫說,約80%至90%的女性為經前症候群所苦。《L.A. Muscle》雜誌警告讀者,約40%至50%的女性為經前症候群所苦,它在女性的身心健康中扮演重要角色。幾年前,甚至《華爾街日報》也有文章談論鈣對經前症候群的療效,並詢問女性讀者:「你們每個月都會變成巫婆嗎?」
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How many people here have heard of PMS? Everybody, right? Everyone knows that women go a little crazy right before they get their period,that the menstrual cycle throws them onto an inevitable hormonal roller coaster of irrationality and irritability. There's a general assumptionthat fluctuations in reproductive hormones cause extreme emotions and that the great majority of women are affected by this. Well, I am here to tell you that scientific evidence says neither of those assumptions is true. I'm here to give you the good news about PMS. But first, let's take a look at how firmly the idea of PMS is entrenched in American culture. If you examine newspaper or magazine articles,you'll see how widely assumed it is that everyone gets PMS. In an article in the magazine Redbook titled "You: PMS Free," readers were informed that between 80 to 90 percent of women suffer from PMS. L.A. Muscle magazine warned its readers that 40 to 50 percent of women suffer from PMS, and that it plays a major role in women's mental and physical health, and a couple of years ago, even the Wall Street Journal ran an article on calcium as a treatment for PMS, asking its female readers, "Do you turn into a witch every month?"
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鑒於有這麼多相關文章,你或許認為肯定有眾多研究證實經前症候群的普遍性。然而,經過五十年的研究,人們對經前症候群的定義、起因、療法、甚至是否存在並未達成強烈共識。心理學家最常用的定義是從排卵開始到月經來潮期間,經前症候群將引發負面行為、認知及身體症狀,但這就是弔詭之處。有超過150種不同症狀被用來診斷經前症候群,這只是其中幾種。好,我想在這裡澄清一下,我不是指女性不會有這些症狀,我是指出現這些症狀不代表你精神異常。當心理學家提出某種症候群定義,卻模糊不清時,這種標籤最後將變得毫無意義。在如此洋洋灑灑的症狀表下,你我都可能有經前症候群,第三排那名男子也可能有經前症候群,我的狗也可能有經前症候群。(笑聲)有些研究員說必須符合五種症狀才算,有些說三種,有些研究員說那些症狀在令你極度困擾時才有意義,但也有人說輕微的症狀也十分重要。多年來,因為經前症候群沒有標準定義,當心理學家試著提出罹病率,他們估計5%至97%的女性有這個病症,因此這意味著幾乎沒有人或幾乎所有人都罹患經前症候群。整體來說,經前症候群的研究方法缺陷相當多。首先,許多研究要求女性回想她們的症狀,仰賴過往的記憶。眾所皆知,這將誇大經前症候群的罹病率。相較於所謂的前瞻性研究,其中受試者至少得連續兩個月每天記錄症狀,許多研究也僅專注於白人中產階級女性,若將研究結果套用在所有女性身上將產生問題。
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From all these articles, you would think there must be a mountain of research verifying the widespread nature of PMS. However, after five decades of research, there's no strong consensus on the definition, the cause, the treatment, or even the existence of PMS. As most commonly defined by psychologists, PMS involves negative behavioral, cognitive and physical symptoms from the time of ovulation to menstruation. But here's where it gets tricky. Over 150 different symptoms have been used to diagnose PMS, and here are just a few of those. Now, I want to be clear here. I'm not saying women don't get some of these symptoms. What I'm saying is that getting some of these symptoms doesn't amount to a mental disorder, and when psychologists come up with a disorder that's so vaguely defined, the label eventually becomes meaningless. With a list of symptoms this long and wide, I could have PMS, you could have PMS, the guy in the third row here could have PMS, my dog could have PMS. (Laughter) Some researchers said you had to have five symptoms. Some said three.Other researchers said that symptoms were only meaningful if they were highly disturbing to you, but others said minor symptoms were just as important. For many years, because there was no standardization in the definition of PMS, when psychologists tried to report prevalence rates, their estimates ranged from five percent of women to 97 percent of women, so at the same time almost no one and almost everyone had PMS. Overall, the weaknesses in the methods of research on PMS have been considerable. First, many studies asked women to report their symptoms retrospectively, looking to the past and relying on memory, which is known to inflate reporting of PMS compared to what's called prospective reporting, which involves keeping a daily log of symptoms for at least two months in a row. Many studies also exclusively focused on white, middle-class women, which makes it problematic to apply study findings to all women.
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我們知道對經前症候群的認定存在強烈的文化因素,因為這在西方國家以外幾乎不曾聽聞。第三,許多研究並未採用控制組,如果我們想瞭解罹患經前症候群之女性的特性,我們必須將她們與未罹患經前症候群之女性比較。最後是使用許多不同類型的問卷診斷經前症候群,專注於不同的症狀、症狀持續時間及嚴重程度。為了對任何病症進行可靠的研究,科學家必須先對造成這種病症的特性達成共識,這樣大家的目標才會一致。但在經前症候群的研究上卻不是這種做法。然而,在1994年精神疾病診斷與統計手冊(俗稱DSM),這也是心理健康專家的指南,他們重新將經前症候群定義為PMDD,即「經前不悅症」。不悅是指焦慮或不安的感覺,根據精神疾病診斷與統計手冊中這項新定義,在去年大部分的月經週期中,十一種可能症狀中至少有五種在月經來潮前一星期內出現。這些症狀在月經來潮後必須改善,這些症狀在月經結束後一週內必須消失,必須出現以下四種症狀之一:顯著的情緒起伏,易怒、焦慮或沮喪,或是來自第一張或第二張投影片的症狀。包括失控的感覺、睡眠或食慾改變。根據精神疾病診斷與統計手冊所言,這些症狀必須具臨床上的顯著困擾,必須對工作、學校或社交生活產生某種程度的影響,必須記錄症狀及其嚴重性至少連續兩個週期,每天做記錄。最後,根據精神疾病診斷與統計手冊所言,情緒困擾不能僅是原有情緒失調程度的加重,因此以科學角度來說這是一項進步。
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We know there's a strong cultural component to the belief in PMS because it's nearly unheard of outside of Western nations. Third, many studies failed to use control groups.If we want to understand the specific characteristics of women who have PMS, we need to be able to compare them to women who don't have PMS. And finally, many different types of questionnaires were used to diagnose PMS, focusing on different symptoms, symptom duration and severity. To do reliable research on any condition, scientists must agree on the specific characteristics that make up that condition so they're all talking about the same thing, and with PMS, this has not been the case. However, in 1994, the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, thankfully -- it's also the manual for mental health professionals -- they redefined PMS as PMDD, Premenstrual Dysphoric Disorder. And dysphoria refers to a feeling of agitation or unease. And according to these new DSM guidelines, in most menstrual cycles in the last year, at least five of 11 possible symptoms must appear in the week before menstruation starts; the symptoms must improve once menstruation has begun; and the symptoms must be absent the week after menstruation has ended. One of these symptoms must come from this list of four: marked mood swings, irritability, anxiety, or depression. The other symptoms could come from the first slide or from those on the second slide, including symptoms like feeling out of control and changes in sleep or appetite. The DSM also required now that the symptoms should be associated with clinically significant distress -- there should be some kind of disturbance in work or school or social relationships -- and that symptoms and symptom severity should now be documented by keeping a daily log for at least two cycles in a row. And finally, the DSM required that the emotional disturbance should be more than simply an exacerbation of an already existing disorder. So scientifically speaking, this is an improvement.
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我們現在定義了有限數量的症狀,必須對生活功能產生巨大影響,症狀的描述及發生時間之定義十分明確。好,藉由這個標準並觀察最近的研究,我們發現平均有3%至8%的女性為經前不悅症所苦。並非所有女性,也並非大部分女性,並非絕大多數女性,甚至不是很多女性:僅有3%至8%。對其他人來說,壓力事件或開心場合等變因,甚至今天星期幾都比月經來潮更能預測情緒。這是科學界自1990年代開始就有的資料。我與幾位同事在2002年發表了一篇論文,講述經前症候群與經前不悅症的研究,還有幾篇相關論文發表在《心理學期刊》上。問題是,為何這些資訊並未傳遞給大眾?為何這些迷思依然存在?好,顯然女性受到書籍、電視、電影及網路資訊的轟炸說每個人都有經前症候群,長期以來這已說服她們這些資訊必定是事實。研究人員告訴我們,女性越相信每個人都有經前症候群的說法,就越可能誤認自己也有這個毛病。我解釋一下所謂「誤認」的意思。你或許問她,「你有經前症候群嗎?」她說有,但當你要求她在兩個月期間每天記錄當時的精神症狀,發現她的症狀與月經來潮毫無關連。另一個使經前症候群迷思歷久不衰的原因與女性角色的狹隘性有關。女性主義心理學家Joan Chrisler指出,替自己貼上經前症候群的標籤使女性得以表達原本被視為不淑女的情緒。幾乎放諸四海皆準的好女人定義是快樂、有愛心、關心他人並滿足於這樣的角色。經前症候群已成為能生氣、抱怨、煩躁卻不會失去好女人頭銜的許可書。我們知道環境中的變數比荷爾蒙更容易引起女性憤怒的情緒,但當她將怒氣歸咎於荷爾蒙,她就能免除責任或批評。「喔,她平常不是那樣的,她只是失控了。」儘管這可以當作有用的工具,卻否定了女性的情緒。當人們以:「喔,她只是大姨媽來了。」這樣的想法回應女性的怒氣,她被人認真看待或有效改變的機會將大受限制。
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We now have a limited number of symptoms, and a high impact on functioning that's required, and the reporting and timing of symptoms have both become very specific. Well, using this criteria and looking at most recent studies, we see that on average, three to eight percent of women suffer from PMDD. Not all women, not most women, not the majority of women, not even a lot of women: three to eight percent. For everyone else, variables like stressful events or happy occasions or even day of the week are more powerful predictors of mood than time of the month, and this is the information the scientific community has had since the 1990s. In 2002, my colleagues and I published an articledescribing the PMS and PMDD research, and several similar articles have appeared in psychology journals. The questions is, why hasn't this information trickled down to the public? Why do these myths persist? Well, certainly the onslaught of messages that women receive from books, TV, movies, the Internet, that everyone gets PMS go a long way in convincing them it must be true. Research tells us that the more a woman believes that everyone gets PMS, the more likely she is to erroneously report that she has it. Let me tell you what I mean by "erroneously." You might ask her, "Do you have PMS?" and she says yes,but then, when you have her keep a daily log of psychological symptoms for two months, no correlation is found between her symptoms and time of the month. Another reason for the persistence of the PMS myth has to do with the narrow boundaries of the feminine role. Feminist psychologists like Joan Chrisler have suggested that taking on the label of PMS allows women to express emotions that would otherwise be considered unladylike. The near universal definition of a good woman is one who is happy, loving, caring for others, and taking great satisfaction from that role. Well, PMS has become a permission slip to be angry, complain, be irritated, without losing the title of good woman. We know that the variables in a woman's environment are much more likely to cause her to be angry than her hormones, but when she attributes anger to hormones, she's absolved of responsibility or criticism. "Oh, that's not who she is. It's out of her control." And while this can be a useful tool, it serves to invalidate women's emotions. When people respond to a woman's anger with the thought, "Oh, it's just that time of the month,"her ability to be taken seriously or effect change is severely limited.
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因此還有誰會從經前症候群的迷思中得利?好,我可以告訴你們,治療經前症候群已成為有利可圖、蓬勃發展的行業。亞馬遜網站最近上架了超過1,900本治療經前症候群的書籍,用Google隨便搜尋就能找到一籮筐的診所、治療室或研討會。聲譽卓著的醫療資源網站,如WebMD或 Mayo Clinic將經前症候群列為常見病症。它並非常見病症,但他們將其放入列表。他們也列出醫師開出的處方,例如抗憂鬱藥物或荷爾蒙。但有趣的是,兩個網站都說治療經前症候群症狀的療效因不同女性而異。好,這不合理。如果你得了某種特定起因的特定病症,經前症候群就屬於此類,那麼在大部分女性身上應該都能看見療效。這些療法並非如此。美國食品藥物管理局的法規說,被視為有效的藥物必須在大部分目標族群中看見臨床上顯著的改善,因此我們並未在這些所謂的療法上看到這一點。然而,經前症候群是常見且可治療的精神症狀,這項迷思所獲得的經濟效益相當可觀。如果女性服用抗憂鬱或荷爾蒙藥物,根據醫療程序,她們必須每三個月回診一次。這是相當頻繁的就醫次數,製藥公司獲得難以估計的利潤。當女人接受她們必須在生育年齡吃處方藥的說法。非處方藥,例如Midol,甚至宣稱可治療經前症候群的症狀,例如緊張和易怒,即使其中的成分只有利尿劑和止痛藥及咖啡因。好,我不瞭解咖啡因的神奇力量,但我不認為它有舒緩緊張情緒的效用。
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So who else benefits from the myth of PMS? Well, I can tell you that treating PMS has become a profitable, thriving industry. Amazon.com currently offers over 1,900 books on PMS treatment. A quick Google search will bring up a cornucopia of clinics, workshops and seminars.Reputable Internet sources of medical information like WebMD or the Mayo Clinic list PMS as a known disorder. It's not a known disorder, but they list it. And they also list the medications that physicians have prescribed to treat it, like anti-depressants or hormones. Interestingly, though, both websites say that the success of medication in treating PMS symptoms vary from woman to woman. Well, that doesn't make sense. If you've got a distinct disorder with a distinct cause, which PMS is supposed to be, then the treatment should bring improvement for a great number of women. This has not been the case with these treatments, and FDA regulations say that for a drug to be deemed effective, a large portion of the target population should see clinically significant improvement. So we have not had that at all with these so-called treatments. However, the financial gain of perpetuating the myth that PMS is a common mental disorder and is treatable is quite substantial. When women are prescribed drugs like anti-depressants or hormones, medical protocol requires that they have physician follow-up every three months. That's a lot of doctor visits. Pharmaceutical companies reap untold profits when women are convinced they should take a prescribed medication for all of their child-bearing lives. Over-the-counter drugs like Midol even claim to treat PMS symptoms like tension and irritability, even though they only contain a diuretic, a pain reliever and caffeine. Now, far be it from me to argue with the magical powers of caffeine, but I don't think reducing tension is one of them.
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自2002年起,Midol開始銷售Teen Midol給青少女,他們早已把目標對準年輕女性,說服她們每個人都有經前症候群,它會讓你變成怪物但等等。你還有救:只要吃Midol,你就能重生為人。2013年Midol的銷售額高達4800萬美元,因此經前症候群迷思的延續將成為某些人的吸金工具,也會為女性帶來一些嚴重的不良後果。第一,它使女性的生育健康醫療化。醫學界有很長一段時間將女性生育過程視為需要治療的疾病,這使我們付出許多代價,包括過多的剖腹產、子宮切除術及荷爾蒙治療藥物,這對女性的傷害遠勝於增進女性的健康。第二,經前症候群迷思也是造成女性易怒及過度情緒化之刻板印象的原因。當月經週期被形容為荷爾蒙雲霄飛車,把女性變成憤怒的野獸,我們很容易質疑所有女性的能力。女性在職場的地位已有極大的進步,但仍然只有極少數女性擔任政府或企業高層職位。當我們考慮什麼樣的人能成為傑出執行長或參議員,腦海裡立刻浮現理性、穩重、有能力等特質,在我們的文化中這似乎更符合男性的形象,而非女性。經前症候群迷思助長了這種想法。心理學家知道男性與女性的情緒大同小異,在一項追蹤男性與女性四至六個月的研究中,發現兩性經歷心情波動的次數及其嚴重性沒什麼不同。
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Since 2002, Midol has marketed a Teen Midol to adolescents.They are aiming at young girls early, to convince them that everyone gets PMS and that it will make you a monster, but wait, there's something you can do about it: Take Midol and you will be a human being again. In 2013, Midol took in 48 million dollars in sales revenue. So while perpetuating the myth of PMS has been lucrative for some, it comes with some serious adverse consequences for women. First, it contributes to the medicalization of women's reproductive health. The medical field has a long history of conceptualizing women's reproductive processes as illnesses that require treatment, and this has come at many costs, including excessive Cesarean deliveries,hysterectomies and prescribed hormone treatments that have harmed rather than enhanced women's health. Second, the PMS myth also contributes to the stereotype of women as irrational and overemotional. When the menstrual cycle is described as a hormonal roller coasterthat turns women into angry beasts, it becomes easy to question the competence of all women. Women have made tremendous strides in the workforce, but still there's a minuscule number of women at the highest echelons of fields like government or business, and when we think about who makes for a good CEO or senator, someone who has qualities like rationality, steadiness, competence come to mind, and in our culture, that sounds more like a man than a woman, and the PMS myth contributes to that. Psychologists know that the moods of men and women are more similar than different. One study followed men and women for four to six months and found that the number of mood swings they experienced and the severity of those mood swings were no different.
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最後,經前症候群迷思使女性逃避造成情緒不佳的真正原因。個人因素:如人際關係品質或工作環境。或社會因素:如種族、性別歧視,或為生計打拼的艱辛都與每天的情緒有很大關係。以經前症候群作為逃避情緒問題的擋箭牌,使女性難以瞭解負面情緒的來源,同時也剝奪她們採取行動以改變現狀的機會。因此關於經前症候群的好消息是,儘管某些女性確實因月經來潮而出現某些症狀,絕大多數女性並未因此而產生精神失調。她們照常工作、上學、照顧家庭、以正常狀態過生活。我們知道男性與女性的情緒及心情大同小異,因此讓我們從將女性視為巫婆這種陳腐的經前症候群迷思中走出,接受絕大多數女性每天都能過著情緒高昂及正常生活的事實。謝謝。(掌聲)
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And finally, the PMS myth keeps women from dealing with the actual issues causing them emotional upset. Individual issues like quality of relationship or work conditions or societal issues like racism or sexism or the daily grind of poverty are all strongly related to daily mood. Sweeping emotions under the rug of PMS keeps women from understanding the source of their negative emotions, but it also takes away the opportunity to take any action to change them. So the good news about PMS is that while some women get some symptoms because of the menstrual cycle, the great majority don't get a mental disorder. They go to work or school, take care of their families, and function at a normal level. We know the emotions and moods of men and women are more similar than different, so let's walk away from the tired old PMS myth of women as witches and embrace the reality of high emotional and professional functioning the great majority of women live every day. Thank you.