SD冠军锦标赛｜美国藤校演讲与辩论赛中国选拔赛

萝缤·史坦·德路卡在TED演讲：经前症候群的好消息，谈论关于如何经前症候群的好消息。

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.

有多少人听过经前症候群 (PMS)？ 大家都听过，对吧？ 大家都知道女人在月经来之前 会有点发神经， 月经周期让她们坐上 无可避免的荷尔蒙导致的 不理性与易怒的云霄飞车。 有个很普遍的说法， 说生殖荷尔蒙波动 会造成极端的情绪， 而且绝大部分妇女都受此影响。 嗯，我在这里告诉大家 科学证据显示 这两个说法都不对。 我要在这里宣布 经前症候群的好消息。

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?”

但首先来看一下 经前症候群这个说法 有多么深植于美国文化。 如果你检视报章杂志的文章， 你就会发现大家都以为 每个人都有经前症候群。 女性杂志《红书》有篇文章标题为： 「妳！从经前症候群释放吧！」 文章告诉读者约有八九成的女性 为经前症候群所苦。 伦敦保健食品杂志则警告读者 有四到五成的妇女 为经前症候群所苦， 而且这还在女性的身心健康 扮演重要角色， 而在几年前，甚至华尔街日报 也有篇文章在谈 钙质如何治疗经前症候群， 并这样问其女性读者， 「妳每个月都变成巫婆吗？」

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.

有这么多文章你可能会想， 一定有如山般铁证 能验证经前症候群的普遍性。 然而，经过五十年的研究， 众人对经前症候群的 定义、起因、疗法， 甚至到底是否存在 都没有强烈共识。 心理学家最常用的定义是， 经前症候群会使人 从排卵开始到月经来其间， 陷入负面的行为、 认知、及身体症状， 但这就是诡异的地方了。 已有超过 150 种不同的症状 被拿来诊断经前症候群， 这里只是其中几种。

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。 我不是说妇女不会有这些症状。 我要说的是有这些症状 并不等于妳精神异常， 心理学家提出某种失调病症， 却定义模糊不清， 这样的标签最终会失去意义。 有这么洋洋洒洒的症状表， 我可能会得经前症候群， 你可能也会， 第三排的男生也会得经前症候群， 连我的狗都会得到经前症候群。 （笑声） 有些研究员说你得要有五种症状， 有些人说三种就好。 还有些研究员说那些症状 要在非常困扰妳时才有意义。 但也有人说轻微的症状也很重要。 多少年了，因为没有统一 定义经前症候群， 当心理学家试着报出患病率， 他们的估计范围是 5% 到 97% 的妇女有这个病症， 意思是同一时间，几乎没有人 或几乎所有人都有经前症候群。

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.

整体来看，经前症候群的 研究方法缺陷相当多。 第一，许多研究要求 妇女回溯她们的症状， 靠着记忆回想过去， 大家都知道这个方法会大量增加 经前症候群的报告数据， 较之于所谓的前瞻性研究， 要受试者每天记录症状 至少连续两个月。 许多研究也只专注在 白人中产阶级妇女， 如果将研究结果应用在 全部妇女会成为问题。 我们知道相信经前症候群与否 有很强的文化要素， 因为这在西方国家以外 几乎是闻所未闻。 第三，许多研究没有设控制组。 如果我们想要了解 有经前症候群妇女的特性， 我们必须要将她们与 没有经前症候群的女性比较。 最后是，使用太多不同型态的问卷 来诊断经前症候群， 专注在不同的症状， 症状持续多久及多严重。 要对任何病症做出可靠的研究， 科学家必须先商定 会造成此病症的特性， 这样大家见解才会一致， 但是对经前症候群 却不是这样研究的。

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 精神疾病诊断与统计手册， 俗称 DSM，还好这么短—— 这也是身心科专家的手册—— 他们重新定义 PMS 成 PMDD， 经前不悦症。 不悦指的是烦躁不安的感觉。 根据这些新的经前不悦症准则， 在过去一年大部分的月经周期中， 至少有五种 11 个可能出现的症状， 在月经来潮前一星期内出现； 这些症状在月经来潮后就改善； 而且这些症状要在 月经结束一周内消失。 一定要有下列四种症状之一： 显着的情绪起伏、 易怒、焦虑或忧虑。 其他的症状则可能是 第一张幻灯片 或第二张幻灯片所列出的， 包括失控的感觉， 睡眠或食欲改变。 经前不悦症还必须有 具临床意义的明显困扰—— 对工作、学校或社交 产生一定程度的影响—— 出现的症状及其严重性 必须记录下来， 至少连续两个周期每天做记录。 最后，经前不悦症的情绪困扰， 其严重性应大于 原有失调的放大效应。 所以从科学角度说， 这是很大的进步。 我们现在得到有限数量的症状， 要对生活功能产生强烈冲击， 而且对症状的描述 及发生时间讲得很明确。 嗯，使用这个标准 并看一下最近的研究， 我们看到平均 有百分之三到八的女性 为经前不悦症所苦。 不再说是所有的女性， 多数的女性， 也不是大部分的女性， 更不是很多女性： 是百分之三到八。 对其它女性，变因像是 压力很大的事件或开心的场合， 甚至今天是星期几 都比月经更能预测情绪， 而这是自 1990 年代开始 科学界就有的资料。 2002 年，我与几个同事 发表了一篇论文 讲述经前症候群 与经前不悦症的研究， 还有几篇类似的论文 也发表在心理学期刊上。 问题是，为什么这样的资讯 还没有流入大众？ 为什么这些迷思依然存在？

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，显然女性长时间 从书籍、电视、电影及网路 接收到的一波波消息， 都说每个人都有经前症候群， 已经说服她们这是事实。 研究人员告诉我们女性愈相信 每个人都有经前症候群的说法， 她就愈有可能错误地说她自己有。 我解释一下我说「错误」的意思。 你可能问她，妳有经前症候群吗？ 她说有， 但之后，在你要她每天记录 精神症状两个月后， 她的症状与月经找不到关连性。

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.

另一个经前症候群迷思 持久不衰的理由 与狭隘的女性角色范围有关。 女性主义心理学家 如乔安克莱斯勒提出， 把自己贴上经前症候群的标签， 让女性能表达原本会被 视为不娴淑的情绪。 几乎放诸四海皆准的好女人定义 是快乐、慈爱、对人充满爱心， 并且对这样的角色很满足。 经前症候群已经成为 能生气、抱怨、烦躁， 却不会失去好女人头衔的同意书。 我们知道女性的环境中有很多变数 比荷尔蒙更容易让她生气， 但是当她将怒气归咎于荷尔蒙， 她就免于责任，也免除了责难。 喔，她平常不是那样的。 她控制不了。 尽管这可以当作有用的工具， 实际上却否定了女性的情绪。 在大家对女性的怒气 用「喔，大姨妈来了」 这样的想法来回应时， 她被人认真看待 或有效改变的机会就大受限制。

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.

那么还有谁会从 经前症候群迷思中得利？ 我可以告诉你们治疗经前症候群 已成为有利可图、蓬勃发展的行业。 亚马逊网站最近放了超过 1,900 本治疗经前症候群的书。 在谷歌上随便找找就能找到 一箩筐的诊所、专讨或研讨会。 声誉良好的医疗资源网站 如网路医师或梅奥医院 将经前症候群列为已知的病症。 这并不是已知的病症， 但他们将其列为之一。 他们也列出医师开出的治疗药物， 如抗忧郁剂或荷尔蒙。 但很有意思的是，两个网站都说 治疗经前症候群的药物 成效因不同女人而异。 这没道理。 如果你得了某种很明确的病症 起因也很明确， 经前症候群就被归为此类， 那么应该会在大部分 女性身上看到治疗成效。 但是这些治疗药物并非如此， 美国食品药物管理局的法规说 某种药物要视为有效， 必须在大部分的目标族群身上 看到有临床意义的改善。 我们还没有在这些 所谓的治疗法上看到这点。 然而，延续此项迷思， 即经前症候群是常见、 可治疗的精神病症， 所得到的经济利益相当可观。 如果妇女接受药物 如抗忧郁剂或荷尔蒙， 医疗计画常规要求她们 必须每三个月回诊一次。 这可是相当大量的就医次数。 制药公司赚进数不清的利润， 就因为女人接受她们必须 在生育年龄吃处方药的说法。 非处方药物如止经痛药 「美多」甚至宣称 可以治疗经前症候群症状， 如紧张及易怒， 即使药物成分只有利尿剂、止痛药 及咖啡因。 那么，我没立场争论 咖啡因的神奇力量， 但我也不认为咖啡因 有减轻紧张的效用。 自 2002 年起，美多开始 销售「婷美多」给青少女。 他们早早把目标对准年轻少女， 说服她们每个人都会得经前症候群， 而且这会让妳变成大怪物， 但是等一下！妳还有救的！ 吃下美多妳就变回人了！ 2013 年，美多的销货收入 为四千八百万美金。

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.

所以延续经前症候群迷思 除了成为某些人吸金的工具外， 还为妇女带来严重的不良后果。 第一，它使女性的生育健康医疗化。 医界有着很长的历史 将女性的生育过程 视为疾病、需要治疗的概念， 而这已造成许多花费， 包括过多的剖腹产、 子宫切除术、及开出荷尔蒙治疗药， 而药物的伤害大于增进妇女健康。 第二，经前症候群迷思也是造成女性 易怒及过度情绪化的刻板印象原因。 一旦月经周期被形容为 荷尔蒙云霄飞车， 把女性变成气呼呼的野兽， 我们就很容易质疑女性的能力。 妇女在工作场合的地位 已有极大的进步， 但是仍然只有极少数的女性 处在政府或企业的高层职位， 而且每次我们考虑什么样的人 可称为好的执行长或参议员， 具有理性、稳健、能力等条件的人 就会在脑中浮现， 在我们的文化，那些条件 听起来更符合男人而非女人， 经前症候群迷思正是助长的原因。

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.

心理学家知道男人与女人的情绪 更趋相似而非相异。 一项研究追踪男人与女人 四到六个月， 发现两性经历心情起伏的次数 及其严重性并没有不同。 最后，经前症候群迷思 不让女性处理 造成他们心烦意乱的真正原因： 个人因素如 人际关系品质或工作环境， 或社会因素如种族歧视、 性别歧视或贫穷的磨难， 都与每天的情绪有很大的关系。 以经前症候群当藉口 逃避情绪问题， 只是让女人更难了解 她们负面情绪的来源， 同时也拿走让她们 以行动来改变情绪的机会。

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.

所以经前症候群的好消息 是有些女人的确因 月经周期而有某些症状， 但大部分的女人并不 因此而得了神经病。 她们照常工作、上学、照顾家庭， 以正常的水准行使职责。 我们知道男人与女人的情绪及心情 更趋相似而非相异， 所以让我们从陈腐的 经前症候群迷思中走出， 不再视女性为巫婆， 而能接受绝大部分女性 每天都过着高情绪 及高专业功能生活的事实。

Thank you.

谢谢。

(Applause)

（掌声）