These Truths Are Not Self-Evident

CW: This piece mentions some difficult topics, including health disorders and suicidal ideation, though graphic details are not included. Please take care of yourself and skip this one if you need to.  🤍  

It was a few months into the pandemic when I realized something was very seriously wrong with me. In the safety of my home, I’d finally begun to unclench and reckon with the last four years of toxic work experiences (an openly misogynistic manufacturing company, an abusive higher ed boss that made it her mission to ruin me, etc, etc). By all accounts, I finally had space and time to heal. My self esteem improved. I accepted that I did the best I could with what little internal resources I had at the time.

But my depressive moods got worse. Much worse. In the years I jumped from one horrible workplace to another, I cycled through severe bouts of depression and dissociation. When the everyday was unbearable, it was impossible to notice any patterns in these moods. Only when my day-to-day life improved dramatically could I see the cycle. Dark intrusive thoughts. Uncontrollable emotions. Insomnia. Blinding, undirected rage. Suicidal ideation. These haunts returned every month in the two weeks before my period. And then, as soon as it started, the curtain lifted, leaving me wondering who that person was just days before.

My nightmare has a name: premenstrual dysphoric disorder (PMDD).

What’s PMDD?

I’d likely been symptomatic for five years before I recognized the pattern. Then, I did as any curious, self-respecting writer would do: I started researching. 

While the exact cause of PMDD is unknown, it’s currently thought to work like this: 

Every month, hormones fluctuate naturally. After menstruation, estrogen rises and peaks around ovulation. Then, during the luteal phase, estrogen and progesterone drop sharply if pregnancy doesn’t occur, reaching their lowest levels at menstruation. This is totally normal. Someone like me with PMDD, however, is extremely sensitive to these natural fluctuations. In other words, the body effectively goes into a state of withdrawal every month during the luteal phase. 

You can think of PMDD like PMS on steroids. Its horsemen are both psychological and physical. Extreme irritability. Brain fog. Insomnia. Pervasive hopelessness. Severe fatigue. A little moodiness can be chalked up to PMS. Voices in your head that… tell you to do bad things to yourself cannot. 

My PMDD is a traitor to my nature and a betrayer of my trust. It’s a captor with a megaphone and a penchant for torture. It’s somehow in equal measure the gun, the shooter, and the unwitting victim. 

Every two weeks the fight begins anew, though there are no victors here. To emerge with my life is to emerge with shame and wonder at the possession of my mind. Some part of me is always in there, imprisoned in the back of my brain while Mr. Hyde gets beamed in from another dimension – its presence loud, unrelenting, and completely uncontrollable – but only because I can call it by its name. 

Burning at the Stake

PMDD is notoriously difficult to diagnose because it can look like other mental health conditions or be dismissed as severe PMS. To complicate matters, PMDD can overlap with and be made worse by major depressive disorder, generalized anxiety disorder, and others. 

This chronic condition is highly treatable with ongoing management, but there is little training around PMDD for doctors and psychiatrists. Finding one who recognizes and is knowledgeable about the condition is a challenge.

Student of rhetoric that I am, I brought years worth of evidence and a fully formed argument to my gynecologist, who was thankfully well-informed and promptly rubber-stamped my diagnosis. But this is not the journey most women with PMDD experience. Many – like Lindsay Clancy, who has the postpartum version of PMDD called postpartum psychosis (PPP) – don’t get the right diagnosis and care in time. 

Up to 1 in 12 women are thought to be affected by PMDD in the United States alone. And yet, most people have never heard of it. 

I understand the appeal of keeping quiet. I did it for nearly a decade. Women have fought so hard to be seen, heard, and respected, and there’s still work to do. Revealing a condition like PMDD risks undoing it all. 

The public response to Lindsay Clancy is itself an argument for hiding this condition. In one corner, you have leagues of women ready to burn her at the stake (literally). In the other, you have women blaming Clancy’s husband, incapable of confronting the reality of her PPP-induced actions. 

But silence risks death. Not just for me, but for everyone white-knuckling their way through PMDD and PPP alone. How many women have to die twice over in the court of ill-informed public opinion and by their own minds before we realize it doesn’t have to be this way?

I hope you don’t need me to tell you I love and care and feel deeply. That I’d like to think my stories can leave this little corner of the universe better than I found it. Does my condition make me incapable? Evil? Deserving of whatever ends befall me? 

When I see Lindsay Clancy on that stand, I see a version of myself that could have been if I had children – if I’d never found a doctor who could help. 

Words Make the World

How easy it’s become to denounce and condemn the world outside the sphere of your immediate influence. Would you turn that hate so quickly on a friend? On a relative?

You can recognize that killing children is wrong while acknowledging flaws in a system that make getting timely, affordable, lifesaving PPP care a near impossibility. You can call for an end to genocide in Palestine without condemning your Jewish neighbor. You can hold your president in contempt without indicting people you love. 

Until we see that governments are not a monument of their people, we’ll keep telling the same stories over again, keep pointing the finger at each other, until one day – too late – we realize our eyes have been trained in the wrong direction. 

We can escape for a time, but we don’t get to opt out of the messiness. Our truths are not, in fact, self-evident; in all our shimmering human complexity, we must fight time and again for our personhood. To create a world in which we lend a hand before we point a weapon. A world hospitable to helping.

The letter of the law knows not our humanity. Systems fail. Empires fall. 

Our task is thus: to keep looking each other in the eye, keep rejecting what is easy for what is right, keep holding space for the uncomfortable, terrifying, beautiful possibility that is life.

Resources for further reading:

• Understanding PMDD and How Symptoms Change as You Get Older - Mayo Clinic
• International Association of Premenstrual Disorders (IAPD)
• Premenstrual dysphoria disorder: It's biology, not a behavior choice - Harvard Health
• Updated insight into the pathophysiology of premenstrual dysphoric disorder and therapeutic approaches - Journal of Affective Disorders

Alicia Boettjer is a creative nonfiction writer whose work has been published in Bending Genres and Hecate magazine. She is the owner of a content marketing business and lives in Cincinnati, Ohio with her husband and cat.