By Kate Cantrell

“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick,” writes Susan Sontag in the opening of her landmark book Illness as Metaphor. Although we prefer to use only our “good passports”, she says, sooner or later each of us will emigrate to “that other place” – the land of the sick.

The lucky ones will spend days there. Others will spend years. Most of us, however, will arrive alone, frightened and entirely unprepared.

Emma Hardy’s debut memoir, Periodic Bitch, is a dispatch from that other place, written by someone who lives there and is determined to understand why.

At 22, Hardy was diagnosed with premenstrual dysphoric disorder (PMDD): a cyclical, hormone-based mood disorder that she describes as “an extreme form of PMS”. Arising during the luteal phase of the menstrual cycle and resolving once menstruation begins, symptoms include depression, anxiety and suicidal ideation, as well as reduced motivation, focus and impulse control.

While Hardy had long experienced an electric irritability, it was only when she told a GP that she felt “stuck in some kind of loop” that she finally received a diagnosis.

Approximately one in 20 people who menstruate live with PMDD, although a recent review of PMDD studies suggests the lifetime prevalence may be higher. This is due to strict diagnostic criteria, gaps in clinical services, and insufficient awareness and training among healthcare professionals.

Many are never diagnosed at all: those with PMDD are sometimes misdiagnosed with bipolar disorder, borderline personality disorder, post-traumatic stress disorder, chronic fatigue syndrome or an autoimmune disease.

It is a chronic condition that is chronically understudied – a problem Hardy attributes, at least in part, to medical misogyny and the endemic sexism of medicine at large.

“It’s funny,” Hardy said in a recent interview, “because my number one symptom for PMDD is anger. But there is so much to be righteously angry about when you have PMDD.”

Since women have around 450 menstrual cycles throughout their lives, PMDD is frequently described as a life curse. On average, the condition robs women and girls of eight cumulative years of their reproductive life. “One week a month for thirty or forty-odd years,” as Hardy puts it, “is a long time.”

Periodic Bitch is a thoughtful, layered memoir that reveals how female pain is mythologised, how little we still know about women’s reproductive health, and how much damage that ignorance continues to cause.

Set in Melbourne’s inner north during the city’s Covid lockdowns – the longest in the world – the memoir captures the claustrophobia and confusion of Hardy’s search for understanding and relief while “trapped indoors”.

“I cannot tell whether what I feel is real,” Hardy writes, “or whether I am being driven crazy.” When she tells another psychologist she no longer wants to live, the response is to work on becoming financially independent and to set some SMART goals: Specific, Measurable, Achievable, Relevant and Time-Bound objectives, typically used in corporate performance rather than crisis support.

In a moving analogy, Hardy compares herself to the “hysterical” narrator of Charlotte Perkins Gilman’s The Yellow Wallpaper (1892). In Gilman’s story, an unnamed woman with postpartum depression is prescribed “a rest cure” by her physician husband – a treatment for mental illness that was disturbingly common for Victorian women.

Forbidden to work and write, and confined to an attic with barred windows, the woman becomes increasingly obsessed with the yellow wallpaper, convinced there is a woman trapped behind it – creeping, watching, waiting to get out.

The work is most compelling when Hardy turns her attention to the history of women’s fraught relationship with institutional medicine and the disturbing foundations of treatments that were developed, ostensibly, in women’s interests.

She reveals, for example, how the contraceptive pill, long celebrated as a tool of women’s liberation, is in fact rooted in a history of eugenics and racism.

Like other menstrual disorders, PMDD is an illness that is mental, physical and cultural all at once.

In Periodic Bitch, Hardy refuses to present PMDD as inherently terrifying. The real horror, she argues, lies elsewhere – in the long history of stigma and wilful misunderstanding surrounding women’s health.

Jokes about women “PMS-ing” trivialise and dismiss; popular representations of menstruation, such as Stephen King’s Carrie, code female anger as monstrous. It is easier to imagine “women driven mad by the very nature of their biology than to imagine the fullness of their desire and rage”.

With unwavering honesty, Hardy moves beyond the cold, clinical lens of medical discourse to expose the gendered nature of illness and to show what life with PMDD is really like. With the obsession of someone who has suffered in silence, she holds the condition up to the light, to scrutinise it from every angle.

Surrender and resistance are common themes in women’s lived experiences of PMDD – and Hardy’s memoir is no exception: she longs for “something better”.

For the millions of women living with PMDD, the stakes could not be higher. One in three women living with PMDD attempts suicide. “I want to be able to know that going into my next cycle,” says one woman, “I’m going to come out alive.”

Kate Cantrell is Senior Lecturer in Humanities, University of Southern Queensland. This article is republished from The Conversation under a Creative Commons licence