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 assumption that 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.

有多少人聽過經前癥候群 (PMS)？ 大家都聽過，對吧？ 大家都知道女人在月經來之前 會有點發神經， 月經周期讓她們坐上 無可避免的荷爾蒙導致的 不理性與易怒的云霄飛車。 有個很普遍的說法， 說生殖荷爾蒙波動 會造成極端的情緒， 而且絕大部分婦女都受此影響。 嗯，我在這里告訴大家 科學證據顯示 這兩個說法都不對。 我要在這里宣布 經前癥候群的好消息。

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?"

但首先來看一下 經前癥候群這個說法 有多么深植于美國文化。 如果你檢視報章雜志的文章， 你就會發現大家都以為 每個人都有經前癥候群。 女性雜志《紅書》有篇文章標題為： 「妳！從經前癥候群釋放吧！」 文章告訴讀者約有八九成的女性 為經前癥候群所苦。 倫敦保健食品雜志則警告讀者 有四到五成的婦女 為經前癥候群所苦， 而且這還在女性的身心健康 扮演重要角色， 而在幾年前，甚至華爾街日報 也有篇文章在談 鈣質如何治療經前癥候群， 并這樣問其女性讀者， 「妳每個月都變成巫婆嗎？」

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.

有這么多文章你可能會想， 一定有如山般鐵證 能驗證經前癥候群的普遍性。 然而，經過五十年的研究， 眾人對經前癥候群的 定義、起因、療法， 甚至到底是否存在 都沒有強烈共識。 心理學家最常用的定義是， 經前癥候群會使人 從排卵開始到月經來其間， 陷入負面的行為、 認知、及身體癥狀， 但這就是詭異的地方了。 已有超過 150 種不同的癥狀 被拿來診斷經前癥候群， 這里只是其中幾種。

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.

那，我要澄清一下。 我不是說婦女不會有這些癥狀。 我要說的是有這些癥狀 并不等于妳精神異常， 心理學家提出某種失調病癥， 卻定義模糊不清， 這樣的標簽最終會失去意義。 有這么洋洋灑灑的癥狀表， 我可能會得經前癥候群， 你可能也會， 第三排的男生也會得經前癥候群， 連我的狗都會得到經前癥候群。 （笑聲） 有些研究員說你得要有五種癥狀， 有些人說三種就好。 還有些研究員說那些癥狀 要在非常困擾妳時才有意義。 但也有人說輕微的癥狀也很重要。 多少年了，因為沒有統一 定義經前癥候群， 當心理學家試著報出患病率， 他們的估計范圍是 5% 到 97% 的婦女有這個病癥， 意思是同一時間，幾乎沒有人 或幾乎所有人都有經前癥候群。

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. 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.

整體來看，經前癥候群的 研究方法缺陷相當多。 第一，許多研究要求 婦女回溯她們的癥狀， 靠著記憶回想過去， 大家都知道這個方法會大量增加 經前癥候群的報告數據， 較之于所謂的前瞻性研究， 要受試者每天記錄癥狀 至少連續兩個月。 許多研究也只專注在 白人中產階級婦女， 如果將研究結果應用在 全部婦女會成為問題。 我們知道相信經前癥候群與否 有很強的文化要素， 因為這在西方國家以外 幾乎是聞所未聞。 第三，許多研究沒有設控制組。 如果我們想要了解 有經前癥候群婦女的特性， 我們必須要將她們與 沒有經前癥候群的女性比較。 最后是，使用太多不同型態的問卷 來診斷經前癥候群， 專注在不同的癥狀， 癥狀持續多久及多嚴重。 要對任何病癥做出可靠的研究， 科學家必須先商定 會造成此病癥的特性， 這樣大家見解才會一致， 但是對經前癥候群 卻不是這樣研究的。

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. 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 article describing 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?

然而，在 1994 年 精神疾病診斷與統計手冊， 俗稱 DSM，還好這么短—— 這也是身心科專家的手冊—— 他們重新定義 PMS 成 PMDD， 經前不悅癥。 不悅指的是煩躁不安的感覺。 根據這些新的經前不悅癥準則， 在過去一年大部分的月經周期中， 至少有五種 11 個可能出現的癥狀， 在月經來潮前一星期內出現； 這些癥狀在月經來潮后就改善； 而且這些癥狀要在 月經結束一周內消失。 一定要有下列四種癥狀之一： 顯著的情緒起伏、 易怒、焦慮或憂慮。 其他的癥狀則可能是 第一張幻燈片 或第二張幻燈片所列出的， 包括失控的感覺， 睡眠或食欲改變。 經前不悅癥還必須有 具臨床意義的明顯困擾—— 對工作、學校或社交 產生一定程度的影響—— 出現的癥狀及其嚴重性 必須記錄下來， 至少連續兩個周期每天做記錄。 最后，經前不悅癥的情緒困擾， 其嚴重性應大于 原有失調的放大效應。 所以從科學角度說， 這是很大的進步。 我們現在得到有限數量的癥狀， 要對生活功能產生強烈沖擊， 而且對癥狀的描述 及發生時間講得很明確。 嗯，使用這個標準 并看一下最近的研究， 我們看到平均 有百分之三到八的女性 為經前不悅癥所苦。 不再說是所有的女性， 多數的女性， 也不是大部分的女性， 更不是很多女性： 是百分之三到八。 對其它女性，變因像是 壓力很大的事件或開心的場合， 甚至今天是星期幾 都比月經更能預測情緒， 而這是自 1990 年代開始 科學界就有的資料。 2002 年，我與幾個同事 發表了一篇論文 講述經前癥候群 與經前不悅癥的研究， 還有幾篇類似的論文 也發表在心理學期刊上。 問題是，為什么這樣的資訊 還沒有流入大眾？ 為什么這些迷思依然存在？

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.

嗯，顯然女性長時間 從書籍、電視、電影及網路 接收到的一波波消息， 都說每個人都有經前癥候群， 已經說服她們這是事實。 研究人員告訴我們女性愈相信 每個人都有經前癥候群的說法， 她就愈有可能錯誤地說她自己有。 我解釋一下我說「錯誤」的意思。 你可能問她，妳有經前癥候群嗎？ 她說有， 但之后，在你要她每天記錄 精神癥狀兩個月后， 她的癥狀與月經找不到關連性。

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.

另一個經前癥候群迷思 持久不衰的理由 與狹隘的女性角色范圍有關。 女性主義心理學家 如喬安克萊斯勒提出， 把自己貼上經前癥候群的標簽， 讓女性能表達原本會被 視為不嫻淑的情緒。 幾乎放諸四海皆準的好女人定義 是快樂、慈愛、對人充滿愛心， 并且對這樣的角色很滿足。 經前癥候群已經成為 能生氣、抱怨、煩躁， 卻不會失去好女人頭銜的同意書。 我們知道女性的環境中有很多變數 比荷爾蒙更容易讓她生氣， 但是當她將怒氣歸咎于荷爾蒙， 她就免于責任，也免除了責難。 喔，她平常不是那樣的。 她控制不了。 盡管這可以當作有用的工具， 實際上卻否定了女性的情緒。 在大家對女性的怒氣 用「喔，大姨媽來了」 這樣的想法來回應時， 她被人認真看待 或有效改變的機會就大受限制。

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. 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.

那么還有誰會從 經前癥候群迷思中得利？ 我可以告訴你們治療經前癥候群 已成為有利可圖、蓬勃發展的行業。 亞馬遜網站最近放了超過 1,900 本治療經前癥候群的書。 在谷歌上隨便找找就能找到 一籮筐的診所、專討或研討會。 聲譽良好的醫療資源網站 如網路醫師或梅奧醫院 將經前癥候群列為已知的病癥。 這并不是已知的病癥， 但他們將其列為之一。 他們也列出醫師開出的治療藥物， 如抗憂郁劑或荷爾蒙。 但很有意思的是，兩個網站都說 治療經前癥候群的藥物 成效因不同女人而異。 這沒道理。 如果你得了某種很明確的病癥 起因也很明確， 經前癥候群就被歸為此類， 那么應該會在大部分 女性身上看到治療成效。 但是這些治療藥物并非如此， 美國食品藥物管理局的法規說 某種藥物要視為有效， 必須在大部分的目標族群身上 看到有臨床意義的改善。 我們還沒有在這些 所謂的治療法上看到這點。 然而，延續此項迷思， 即經前癥候群是常見、 可治療的精神病癥， 所得到的經濟利益相當可觀。 如果婦女接受藥物 如抗憂郁劑或荷爾蒙， 醫療計畫常規要求她們 必須每三個月回診一次。 這可是相當大量的就醫次數。 制藥公司賺進數不清的利潤， 就因為女人接受她們必須 在生育年齡吃處方藥的說法。 非處方藥物如止經痛藥 「美多」甚至宣稱 可以治療經前癥候群癥狀， 如緊張及易怒， 即使藥物成分只有利尿劑、止痛藥 及咖啡因。 那么，我沒立場爭論 咖啡因的神奇力量， 但我也不認為咖啡因 有減輕緊張的效用。 自 2002 年起，美多開始 銷售「婷美多」給青少女。 他們早早把目標對準年輕少女， 說服她們每個人都會得經前癥候群， 而且這會讓妳變成大怪物， 但是等一下！妳還有救的！ 吃下美多妳就變回人了！ 2013 年，美多的銷貨收入 為四千八百萬美金。

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 coaster that 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.

所以延續經前癥候群迷思 除了成為某些人吸金的工具外， 還為婦女帶來嚴重的不良后果。 第一，它使女性的生育健康醫療化。 醫界有著很長的歷史 將女性的生育過程 視為疾病、需要治療的概念， 而這已造成許多花費， 包括過多的剖腹產、 子宮切除術、及開出荷爾蒙治療藥， 而藥物的傷害大于增進婦女健康。 第二，經前癥候群迷思也是造成女性 易怒及過度情緒化的刻板印象原因。 一旦月經周期被形容為 荷爾蒙云霄飛車， 把女性變成氣呼呼的野獸， 我們就很容易質疑女性的能力。 婦女在工作場合的地位 已有極大的進步， 但是仍然只有極少數的女性 處在政府或企業的高層職位， 而且每次我們考慮什么樣的人 可稱為好的執行長或參議員， 具有理性、穩健、能力等條件的人 就會在腦中浮現， 在我們的文化，那些條件 聽起來更符合男人而非女人， 經前癥候群迷思正是助長的原因。

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. 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.

心理學家知道男人與女人的情緒 更趨相似而非相異。 一項研究追蹤男人與女人 四到六個月， 發現兩性經歷心情起伏的次數 及其嚴重性并沒有不同。 最后，經前癥候群迷思 不讓女性處理 造成他們心煩意亂的真正原因： 個人因素如 人際關系品質或工作環境， 或社會因素如種族歧視、 性別歧視或貧窮的磨難， 都與每天的情緒有很大的關系。 以經前癥候群當藉口 逃避情緒問題， 只是讓女人更難了解 她們負面情緒的來源， 同時也拿走讓她們 以行動來改變情緒的機會。

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.

所以經前癥候群的好消息 是有些女人的確因 月經周期而有某些癥狀， 但大部分的女人并不 因此而得了神經病。 她們照常工作、上學、照顧家庭， 以正常的水準行使職責。 我們知道男人與女人的情緒及心情 更趨相似而非相異， 所以讓我們從陳腐的 經前癥候群迷思中走出， 不再視女性為巫婆， 而能接受絕大部分女性 每天都過著高情緒 及高專業功能生活的事實。

Thank you.

謝謝。

(Applause)

（掌聲）

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