蘿繽·史坦·德路卡在TED演講：經(jīng)前癥候群的好消息 (雙語(yǔ)++mp3)

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(jīng)前癥候群 (PMS)？ 大家都聽過，對(duì)吧？ 大家都知道女人在月經(jīng)來之前 會(huì)有點(diǎn)發(fā)神經(jīng)， 月經(jīng)周期讓她們坐上 無可避免的荷爾蒙導(dǎo)致的 不理性與易怒的云霄飛車。 有個(gè)很普遍的說法， 說生殖荷爾蒙波動(dòng) 會(huì)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(xué)證據(jù)顯示 這兩個(gè)說法都不對(duì)。 我要在這里宣布 經(jīng)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(jīng)前癥候群這個(gè)說法 有多么深植于美國(guó)文化。 如果你檢視報(bào)章雜志的文章， 你就會(huì)發(fā)現(xiàn)大家都以為 每個(gè)人都有經(jīng)前癥候群。 女性雜志《紅書》有篇文章標(biāo)題為： 「妳！從經(jīng)前癥候群釋放吧！」 文章告訴讀者約有八九成的女性 為經(jīng)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(jīng)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?qǐng)?bào) 也有篇文章在談 鈣質(zhì)如何治療經(jīng)前癥候群， 并這樣問其女性讀者， 「妳每個(gè)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(huì)想， 一定有如山般鐵證 能驗(yàn)證經(jīng)前癥候群的普遍性。 然而，經(jīng)過五十年的研究， 眾人對(duì)經(jīng)前癥候群的 定義、起因、療法， 甚至到底是否存在 都沒有強(qiáng)烈共識(shí)。 心理學(xué)家最常用的定義是， 經(jīng)前癥候群會(huì)使人 從排卵開始到月經(jīng)來其間， 陷入負(fù)面的行為、 認(rèn)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(jīng)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(huì)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(xué)家提出某種失調(diào)病癥， 卻定義模糊不清， 這樣的標(biāo)簽最終會(huì)失去意義。 有這么洋洋灑灑的癥狀表， 我可能會(huì)得經(jīng)前癥候群， 你可能也會(huì)， 第三排的男生也會(huì)得經(jīng)前癥候群， 連我的狗都會(huì)得到經(jīng)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(shí)才有意義。 但也有人說輕微的癥狀也很重要。 多少年了，因?yàn)闆]有統(tǒng)一 定義經(jīng)前癥候群， 當(dāng)心理學(xué)家試著報(bào)出患病率， 他們的估計(jì)范圍是 5% 到 97% 的婦女有這個(gè)病癥， 意思是同一時(shí)間，幾乎沒有人 或幾乎所有人都有經(jīng)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(jīng)前癥候群的 研究方法缺陷相當(dāng)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(gè)方法會(huì)大量增加 經(jīng)前癥候群的報(bào)告數(shù)據(jù)， 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(xù)兩個(gè)月。 許多研究也只專注在 白人中產(chǎn)階級(jí)婦女， 如果將研究結(jié)果應(yīng)用在 全部婦女會(huì)成為問題。 我們知道相信經(jīng)前癥候群與否 有很強(qiáng)的文化要素， 因?yàn)檫@在西方國(guó)家以外 幾乎是聞所未聞。 第三，許多研究沒有設(shè)控制組。 如果我們想要了解 有經(jīng)前癥候群婦女的特性， 我們必須要將她們與 沒有經(jīng)前癥候群的女性比較。 最后是，使用太多不同型態(tài)的問卷 來診斷經(jīng)前癥候群， 專注在不同的癥狀， 癥狀持續(xù)多久及多嚴(yán)重。 要對(duì)任何病癥做出可靠的研究， 科學(xué)家必須先商定 會(huì)造成此病癥的特性， 這樣大家見解才會(huì)一致， 但是對(duì)經(jīng)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(tǒng)計(jì)手冊(cè)， 俗稱 DSM，還好這么短—— 這也是身心科專家的手冊(cè)—— 他們重新定義 PMS 成 PMDD， 經(jīng)前不悅癥。 不悅指的是煩躁不安的感覺。 根據(jù)這些新的經(jīng)前不悅癥準(zhǔn)則， 在過去一年大部分的月經(jīng)周期中， 至少有五種 11 個(gè)可能出現(xiàn)的癥狀， 在月經(jīng)來潮前一星期內(nèi)出現(xiàn)； 這些癥狀在月經(jīng)來潮后就改善； 而且這些癥狀要在 月經(jīng)結(jié)束一周內(nèi)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(jīng)前不悅癥還必須有 具臨床意義的明顯困擾—— 對(duì)工作、學(xué)校或社交 產(chǎn)生一定程度的影響—— 出現(xiàn)的癥狀及其嚴(yán)重性 必須記錄下來， 至少連續(xù)兩個(gè)周期每天做記錄。 最后，經(jīng)前不悅癥的情緒困擾， 其嚴(yán)重性應(yīng)大于 原有失調(diào)的放大效應(yīng)。 所以從科學(xué)角度說， 這是很大的進(jìn)步。 我們現(xiàn)在得到有限數(shù)量的癥狀， 要對(duì)生活功能產(chǎn)生強(qiáng)烈沖擊， 而且對(duì)癥狀的描述 及發(fā)生時(shí)間講得很明確。 嗯，使用這個(gè)標(biāo)準(zhǔn) 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(jīng)前不悅癥所苦。 不再說是所有的女性， 多數(shù)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(duì)其它女性，變因像是 壓力很大的事件或開心的場(chǎng)合， 甚至今天是星期幾 都比月經(jīng)更能預(yù)測(cè)情緒， 而這是自 1990 年代開始 科學(xué)界就有的資料。 2002 年，我與幾個(gè)同事 發(fā)表了一篇論文 講述經(jīng)前癥候群 與經(jīng)前不悅癥的研究， 還有幾篇類似的論文 也發(fā)表在心理學(xué)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(zhǎng)時(shí)間 從書籍、電視、電影及網(wǎng)路 接收到的一波波消息， 都說每個(gè)人都有經(jīng)前癥候群， 已經(jīng)說服她們這是事實(shí)。 研究人員告訴我們女性愈相信 每個(gè)人都有經(jīng)前癥候群的說法， 她就愈有可能錯(cuò)誤地說她自己有。 我解釋一下我說「錯(cuò)誤」的意思。 你可能問她，妳有經(jīng)前癥候群?jiǎn)幔?她說有， 但之后，在你要她每天記錄 精神癥狀兩個(gè)月后， 她的癥狀與月經(jīng)找不到關(guān)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(gè)經(jīng)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(guān)。 女性主義心理學(xué)家 如喬安克萊斯勒提出， 把自己貼上經(jīng)前癥候群的標(biāo)簽， 讓女性能表達(dá)原本會(huì)被 視為不嫻淑的情緒。 幾乎放諸四海皆準(zhǔn)的好女人定義 是快樂、慈愛、對(duì)人充滿愛心， 并且對(duì)這樣的角色很滿足。 經(jīng)前癥候群已經(jīng)成為 能生氣、抱怨、煩躁， 卻不會(huì)失去好女人頭銜的同意書。 我們知道女性的環(huán)境中有很多變數(shù) 比荷爾蒙更容易讓她生氣， 但是當(dāng)她將怒氣歸咎于荷爾蒙， 她就免于責(zé)任，也免除了責(zé)難。 喔，她平常不是那樣的。 她控制不了。 盡管這可以當(dāng)作有用的工具， 實(shí)際上卻否定了女性的情緒。 在大家對(duì)女性的怒氣 用「喔，大姨媽來了」 這樣的想法來回應(yīng)時(shí)， 她被人認(rèn)真看待 或有效改變的機(jī)會(huì)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(shuí)會(huì)從 經(jīng)前癥候群迷思中得利？ 我可以告訴你們治療經(jīng)前癥候群 已成為有利可圖、蓬勃發(fā)展的行業(yè)。 亞馬遜網(wǎng)站最近放了超過 1,900 本治療經(jīng)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(huì)。 聲譽(yù)良好的醫(yī)療資源網(wǎng)站 如網(wǎng)路醫(yī)師或梅奧醫(yī)院 將經(jīng)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(yī)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(gè)網(wǎng)站都說 治療經(jīng)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(jīng)前癥候群就被歸為此類， 那么應(yīng)該會(huì)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(guó)食品藥物管理局的法規(guī)說 某種藥物要視為有效， 必須在大部分的目標(biāo)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(diǎn)。 然而，延續(xù)此項(xiàng)迷思， 即經(jīng)前癥候群是常見、 可治療的精神病癥， 所得到的經(jīng)濟(jì)利益相當(dāng)可觀。 如果婦女接受藥物 如抗憂郁劑或荷爾蒙， 醫(yī)療計(jì)畫常規(guī)要求她們 必須每三個(gè)月回診一次。 這可是相當(dāng)大量的就醫(yī)次數(shù)。 制藥公司賺進(jìn)數(shù)不清的利潤(rùn)， 就因?yàn)榕私邮芩齻儽仨?在生育年齡吃處方藥的說法。 非處方藥物如止經(jīng)痛藥 「美多」甚至宣稱 可以治療經(jīng)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(chǎng)爭(zhēng)論 咖啡因的神奇力量， 但我也不認(rèn)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?cè)缭绨涯繕?biāo)對(duì)準(zhǔn)年輕少女， 說服她們每個(gè)人都會(huì)得經(jīng)前癥候群， 而且這會(huì)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(wàn)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(xù)經(jīng)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(yán)重的不良后果。 第一，它使女性的生育健康醫(yī)療化。 醫(yī)界有著很長(zhǎng)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(fèi)， 包括過多的剖腹產(chǎn)、 子宮切除術(shù)、及開出荷爾蒙治療藥， 而藥物的傷害大于增進(jìn)婦女健康。 第二，經(jīng)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(jīng)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(zhì)疑女性的能力。 婦女在工作場(chǎng)合的地位 已有極大的進(jìn)步， 但是仍然只有極少數(shù)的女性 處在政府或企業(yè)的高層職位， 而且每次我們考慮什么樣的人 可稱為好的執(zhí)行長(zhǎng)或參議員， 具有理性、穩(wěn)健、能力等條件的人 就會(huì)在腦中浮現(xiàn)， 在我們的文化，那些條件 聽起來更符合男人而非女人， 經(jīng)前癥候群迷思正是助長(zhǎng)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(xué)家知道男人與女人的情緒 更趨相似而非相異。 一項(xiàng)研究追蹤男人與女人 四到六個(gè)月， 發(fā)現(xiàn)兩性經(jīng)歷心情起伏的次數(shù) 及其嚴(yán)重性并沒有不同。 最后，經(jīng)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(gè)人因素如 人際關(guān)系品質(zhì)或工作環(huán)境， 或社會(huì)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(guān)系。 以經(jīng)前癥候群當(dāng)藉口 逃避情緒問題， 只是讓女人更難了解 她們負(fù)面情緒的來源， 同時(shí)也拿走讓她們 以行動(dòng)來改變情緒的機(jī)會(huì)。

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(jīng)前癥候群的好消息 是有些女人的確因 月經(jīng)周期而有某些癥狀， 但大部分的女人并不 因此而得了神經(jīng)病。 她們照常工作、上學(xué)、照顧家庭， 以正常的水準(zhǔn)行使職責(zé)。 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(jīng)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(yè)功能生活的事實(shí)。

Thank you.

謝謝。

(Applause)

（掌聲）

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