Resisting the Mantle of the Monstrous Feminine: Women’s Construction and Experience of Premenstrual Embodiment


This chapter uses a feminist material-discursive theoretical framework to examine how women adopt the subject position of ‘monstrous feminine’ via the role of premenstrual embodiment. In this examination, Ussher and Perz draw on interviews they conducted with women who self-diagnose as ‘PMS sufferers.’ They theorize that this self-positioning is subjectification, wherein women take up cultural discourse regarding idealized femininity and the stigmatized fat body; according to the authors, this results in distress, self-objectification, and self-condemnation. However, they argue that women can reduce premenstrual distress and resist negative cultural constructions of premenstrual embodiment and fat bodies through women-centered psychological therapy, which increases awareness of embodied change and leads to greater self-care and acceptance of the premenstrual body.

The bio-medical model which dominates research and treatment on PMS and PMDD, implicitly positions women's difference and deficiency as inevitable, and open to bio-medical 'intervention' . Thus in 1931, when 'Premenstrual Tension' first appeared in the medical literature, it was attributed to the 'female sex hormone' estrogen and regulated through correction of hormonal 'imbalance' (Frank 1931). In the intervening years, many different bio-medical theories of premenstrual symptomatology have been put forward, which have led to the adoption of a range of pharmacological interventions, with serotonin-reuptake inhibitors (SSRIs) currently recommended as "first line treatment" for PMDD (Ismaili et al. 2016).
At the same time, a gamut of psychological theories have been proffered to explain premenstrual distress, leading to the endorsement of Cognitive Behavior Therapy (CBT) as an effective solution (Kleinstäuber, Witthöft, and Hiller 2012). The body has a somewhat peripheral presence within this model of PMS, with distress assumed to arise from 'cognitive distortions,' and interventions focusing on women's psychological reappraisal of emotional and behavioral change premenstrually, alongside the development of behavioral coping mechanisms (Blake 1995). Common to both bio-medical and psychological models is that embodied change is positioned as a 'symptom' of PMS or PMDD, a material manifestation of disorder within. This is expressed as premenstrual bloating, swelling, breast tenderness, joint or muscle pain, headaches, and for some women, diarrhea and hot flushes (Endicott and Harrison 1990). However, such change has to be accompanied by a psychological 'symptom,' such as depression, anxiety or anger, to warrant diagnosis of a premenstrual 'disorder' (American Psychiatric Association 2013), implicitly positioning the body at the periphery of diagnosis of premenstrual disorders (PMDs).

reSearching PreMenStrUal eMBodiMent: PoSitiviSM verSUS critical realiSM
Psychologists have made some attempt to examine the nature and function of embodied premenstrual change, reporting that body image 'distortion' and body dissatisfaction is higher in the premenstrual phase of the cycle in the 'normal' female population who don't self-position as PMS sufferers (Kaczmarek and Trambacz-Oleszak 2016;Teixeira et al. 2013;Jappe and Gardner 2009;Carr-Nangle et al. 1994;Racine et al. 2012). In those women who do present with PMDs, levels of premenstrual symptom severity have been reported to be associated with body image disturbance (Muljat, Lustyk, and Miller 2007) and with body dissatisfaction (Kleinstäuber et al. 2016). Conducted through survey methods, which correlate menstrual cycle phase or premenstrual distress with perception of body size or body satisfaction, this body of research has proven inconclusive in determining whether "body dissatisfaction or a disturbed body image are vulnerability factors for, or consequences of premenstrual complaints" (Kleinstäuber et al. 2016, 761). This particular question, and the body of correlational research that informs it, is framed within a positivist epistemological standpoint (Keat 1979), which understands causality in terms of antecedent conditions and general laws governing phenomena, and utilizes the scientific method-in this case standardized survey instruments and statistical analysis-to 'objectively' examine variables of interest (Ussher 2005). What is absent from this analysis is the meaning and experience of embodied change from the perspective of women who inhabit the unruly premenstrual body, in the context of broader constructions of femininity and embodiment. Feminist social constructionists have provided insight into the role of cultural discourse in the pathologization of the premenstrual woman (Chrisler 2004), as outlined above. However, social constructionism has been criticized for ignoring the "real" (Speer 2000), and marginalizing experience outside of the realm of language, in particular embodiment (Sims-Schouten, Riley, and Willig 2007). This is problematic, as a substantial proportion of women do perceive or experience emotional changes during the premenstrual phase of the cycle (Nevatte et al. 2013;Ussher andPerz 2013a, 2013b), as well as corporeral changes, including water retention and bloating (White et al. 2011), of that there is no doubt. It can also be seen to negate embodied or psychological change across the menstrual cycle, or other material aspects of women's existence that may be associated with their distress (Ussher 2005).
A critical realist epistemology (Bhaskar 1989) allows us to acknowledge the materiality of change across the menstrual cycle, including changes in corporeality, mood, or women's perception of embodied change, but also conceptualize this materiality as mediated by culture, language and politics. Described as a material-discursive standpoint (Ussher 2008b), critical realism has been positioned as a way forward for research examining embodiment in a sociocultural context (Williams 2003).
In the remainder of this chapter, we adopt a critical realist epistemology and a material-discursive framework to explore the implications of changes in premenstrual embodiment, and constructions of the idealized feminine body, on women's acceptance and resistance of the position of the monstrous feminine. We do this through drawing on interviews with women who self-identified as PMS sufferers, collected as part of a study examining the efficacy of a women-centered psychological therapy for moderate to severe premenstrual distress (which we henceforth define as PMS), the methodology and results of which are presented elsewhere (Ussher and Perz 2017). In summary, we interviewed 83 women, average age 35, who reported moderate-severe PMS, confirmed by three months of daily diary completion, about their subjective experience of premenstrual change. In the accounts below, we examine women's experience of premenstrual embodiment, prior to and after taking part in the psychological therapy.

"I Feel Fat and Ugly and Hate Myself": Self-Objectification and Dehumanization
The majority of women we interviewed reported negative feelings toward their bodies, and by implication their very selves, when they were premenstrual, describing themselves as "fat," "ugly," "a blimp," "gross," "frumpy," "sluggish," "disgusting," "lumpy," "sludgy," and "unattractive." In these accounts, negative feelings were attributed to perception of embodied change premenstrually, such as "bloating," "tenderness in the breasts," and "breasts that feel bigger," illustrated in the example below.
I'm more bloated my boobs are already big so they're heaps bigger, my stomach's swollen and generally I feel quite puffy and fluid filled so I wouldn't say I feel particularly attractive at that time.
This bloating and self-positioning as "fat" was associated with perception of premenstrual weight gain. Women told us: "Two kilos goes on and it just makes me feel like crap, puffy in the face and round the guts, like right around my abdomen just puffs up"; and "physically I just feel about five times heavier than normal and bloated." Women explicitly described these changes as acting to annihilate their "self-confidence," "sense of being attractive," and "self-esteem"-their very sense of self as a woman. As one participant told us: "Yes I hate myself, I don't have any self-confidence and don't even want to look in any mirror." In contrast, women said that they felt "less concerned" about their bodies, or positioned them as "OK," when they were not premenstrual. These accounts suggest a form of self-objectification (Fredrickson and Roberts 1997), wherein women have internalized a critical gaze that finds them wanting, because the "bloated," "fat" premenstrual body does not conform to the slim, contained, and feminine ideal. Similar accounts of surveillance and internalized judgment, have been found in interviews with women who position themselves as "overweight" or "obese" (Tischner 2013). Women's body fat is discursively positioned as ugly and stigmatizing within western culture, associated with loathing, disgust, and revulsion (Lupton 2013), with women expected to discipline and regulate the body, and thus the self, to maintain a slim, contained form (Chrisler 2011;Bordo 1993). Body fat is positioned as both a threat to health and morality (Lupton 2013), with "excess" fat a sign of women "letting themselves go" at both levels (Chrisler 2011, 205). Many women reported a disruption in their normal patterns of dietary retraint or "healthy eating" premenstrually, feeling "desperately in need of chocolate," or "down and depressed so I'd eat blocks of chocolate and chips." It is thus not surprising to find that women experience distress and self-loathing in relation to perceptions of a "fat" premenstrual body that "takes up more space." Hatred of the fat body, and by implication the self, was evident in many women's accounts, with animalistic metaphors often being used. For example, "I feel like an elephant, very unattractive"; "I look at myself and I go 'You big fat pig,' I hate it"; "you're feeling revolting in yourself . . . you don't feel as feminine. I look like a dragon"; "I feel like a whale and hate my body during this time"; and "I feel like a frog . . . heavy, bloated, slow and lethargic." Animal metaphors are associated with dehumanization (Haslam, Loughnan, and Sun 2011) and social exclusion (Andrighetto et al. 2016), signifying a base and immoral nature, that lacks agency and rationality (Haslam 2006). Women who are animalized are positioned as creatures of emotion, nature and desire, and inferior to men (Tipler and Ruscher 2017), with pig and whale metaphors, in particular, signifying depravity (Haslam, Loughnan, and Sun 2011). Such dehumanization is also associated with the objectification of the female body (Morris, Goldenberg, and Boyd 2018), and thus self-positioning as animalistic serves to both denigrate the reproductive body and reinforce women's self-objectification during the premenstrual phase of the cycle. As the specific animal metaphors used by women signify fatness, self-hatred of premenstrual embodiment cannot be separated from the all-powerful cultural hatred of fatness.

"I Feel Really Exposed": Concealment and Separation of Self from the Unruly Premenstrual Body
People go to great lengths to distance themselves from or conceal their own 'beastly' animality (Haslam, Loughnan, and Sun 2011) or 'creatureliness' (Goldenberg et al. 2001). In this vein, visibility, and invisibility was central to the disciplining of the uncontained premenstrual body, associated with fear of surveillance from others, as well as constant self-surveillance. Many women attempted to conceal the premenstrual body from the critical gaze of others, reporting wearing "baggy clothes," "different clothes," "never leaving the house," or "staying away from the beach." This wasn't positioned as a form of coping or self-care in the face of discomfort-strategies that can reduce premenstrual distress (Ussher and Perz 2013b), but rather as a concealment of premenstrual abjection, and a resignation to making "less effort," all of which appeared to serve to add to women's distress.
I do definitely feel bloated probably around that time, and so I won't wear the same clothes, I'll wear more frumpy sort of clothes and then I don't feel as good about myself as well. And that probably adds a little bit to the negative moods.
Women's attempts to conceal the fecund body reflects internalization of the discourse of the reproductive body as unclean and a source of pollution , which contributes to menstrual stigma and shame (Johnston-Robledo et al. 2007;Chrisler 2011). As one woman told us: I feel that others are able to see my bloated stomach and recognise in me that I'm walking around premenstrual. It's like I'm carrying an extra burden of woman-ness around and I feel really exposed by that.
Another woman said "I change how I dress because I don't want to draw attention to the fact I'm about to bleed." Concealment of biological functioning is part of women's bodywork (Roberts 2004), and thus self-objectification serves as a "flight from corporeality" (Goldenberg et al. 2001) that 'thingifies' the premenstrual body and separates it from the self. For many women, concealment was also focused on hiding "large," "swollen," "problematic breasts," that "go up a bra size." For example, "my breasts arrive a long time before I do if I've got PMS . . . I can be really self-conscious and embarrassed about it, so I try to cover it up"; "I feel my tits are so big that I can't put them in a particular shirt. So I'll want to hide them." These accounts reflect the positioning of a woman's breasts as signifiers of feminine sexuality (Young 1992), with large breasts associated with greater sexual objectification of women on the part of men (Gervais, Holland, and Dodd 2013). This can result in women feeling that they are constantly under surveillance and that their large breasts make them more noticeable and visible than other women (Millsted and Frith 2003). Whilst some women feel 'more attractive' as a result of premenstrual breast changes (King and Ussher 2013), or having large breasts (Millsted and Frith 2003), the accounts of women we interviewed reflect the greater body shame and social physique anxiety associated with an anticipated male gaze and objectification (Calogero 2004).

"I Feel Betrayed by My Body": Condemning Premenstrual Corporeality
Implicit in accounts of premenstrual embodiment is a body outside of the woman's control, undermining idealized femininity, wherein self-control is expected of 'good' women (Chrisler 2008). This was evident in accounts where women described the premenstrual body as a separate entity that was "doing" something to them, as evidenced in the following account: 'I hated my body very much for what it did to me . . . By 'hating my body for what it did' I mean everything, not just the physical effects." In this vein, many women condemned and further separated themselves from the premenstrual body, reporting feeling "betrayed," "disappointed," or "let down" by embodied changes. The 'out of control' premenstrual body is both positioned as cause of the woman feeling "fat" and "flabby," but also cause of her unruly emotions, illustrated in the example below.
I tend to put on a little bit of weight and stuff during that time too. So that makes me angry, because I am upset about that, and then I tend to take it out on other people.
The body is also implicated more broadly as a cause of premenstrual distress, described variously by women as caused by "crazy hormones," a "biological process" and "illness": I don't have control over how many hormones are flying about in my body, or anything like that.
I feel like my hormones are not balanced, like they're completely out of whack. And -and then the brain whatever function. I definitely feel that it's, for it's biological, you know, affecting the way I think and feel.
The unruly premenstrual body therefore stands as a double assault on femininity-abhorrent, animalistic, fat, and "taking up more space," as well as out of control-the embodiment of the monstrous feminine . If women see themselves as uncontained and at the mercy of raging hormones or fatness, they position themselves as being attacked from within. The body becomes further objectified, alien to the woman, something that is acting against her . This blaming of the body may appear to function to exonerate the woman from judgments that attack her sense of self, as her abject corporeality and emotional transgressions are split off and projected onto a pathological condition, over which she has no control. Yet, as the focus of this projection is the reproductive body, which is implicitly positioned as disordered, unruly, and deviant, the outcome of this self-policing is a direct assault on the woman's corporeality (Ussher 2011). As Joan Chrisler argues, the fear of loss of control, and worry that others think we are out of control, serves as a form of "internalized oppression" that acts to "enforce gender roles and keep women from developing authentic selves" (Chrisler 2008, 8). However, this is not an inevitable process. Women can experience and acknowledge changes in premenstrual embodiment, without fear of loss of control or denigration of the self. The pull of the monstrous feminine can be resisted or reframed.

reFraMing PreMenStrUal eMBodiMent: reSiSting the PoSition oF MonStroUS FeMinine
The women we interviewed all reported embodied change during the premenstrual phase of the cycle. However, these changes are not 'pure,' somehow beyond culture, beyond discourse. They are not simply caused by the reproductive body, by a syndrome called 'PMS.' And they are not inevitably experienced as distressing or problematic. It is important to acknowledge women's agency in negotiation of premenstrual change, and their ability to cope and make sense of premenstrual corporeality (Ussher and Perz 2013b). For example, let us examine the debate about the reality of increases in body weight or "dimensions" during the premenstrual phase of the cycle. One study reported that whilst women reported premenstrual bloating, "objective" measurement could find no change, and the "discrepancy between the perceived body size and the actual body size (perception error) was significant" (Faratian et al. 1984). This may suggest that women are experiencing a "distortion of body image" premenstrually, a change in how they construct and position the body, rather than a material change in the body. Many women we interviewed appeared to construct embodied change in such a manner, aware that such change was more perceptual than material, and even describing corporeal self-condemnation as "irrational," as evidenced by the following extracts: Yes. I feel unattractive. I know I still look the same -it is all in my mind but that doesn't make me feel any better. I feel fat. I also will dress differently at that time of the month. I see all faults and feel that they are larger than they are (that is, my stomach, thighs) to the point that I can't stand to look at myself. Some women told us that their partner reassured them that they "look as good today as you do any other time," but this had no impact, in the face of their "inner critic," which led one woman to say: "I feel fat. I feel ugly, I feel unattractive, unwanted. I feel really paranoid." In these accounts, women are both undermining the legitimacy of the embodied change that is the focus of their self-condemnation, and at the same time reinforcing self-criticism, by positioning hatred of the body as "irrational" or "paranoia," a manifestation of the pathology that is "PMS." However, women are also demonstrating awareness that they are perceiving the premenstrual body as "fat and ugly" and taking up the subject position of monstrous feminine as a result of this perception, which opens the door to the possibility of a reframing of both embodiment and the premenstrual self. This awareness is the first step in developing strategies of self-acceptance and self-care, and as a result, resisting self-objectification and self-positioning as the monstrous feminine (Ussher and Perz 2013b). It is a process that can be facilitated through women-centred psychological therapy.
Social constructionist and feminist critics have sometimes been critical of psychological 'intervention,' positioning it as a disciplinary practice that engenders self-policing through therapy, following a process of pathologization (Fee 2000;Foucault 1979;Ussher 2011). Women are told by experts within the 'psy-professions' others that they have a problem, and are then effectively positioned within the realm of psychiatric diagnosis and treatment, with all the regulation and subjugation that this entails (Ussher 2013).
However, we believe it is possible to simultaneously acknowledge the regulatory power of discourse and the role of the medical and psy-professions in women's subjectification, at the same time as recognizing the very real existence of distress, and the embodied or psychological changes women themselves experience associated with the fecund body. In order to do this, we have been involved in the development and evaluation of a non-pathologizing means of therapeutic support for women which acknowledges individual agency and the complex negotiations women engage in as they make sense of premenstrual change, with the aim of facilitating the adoption of strategies of self-care and coping (Ussher 2002). Drawing on both a narrative re-authoring framework (Guilfoyle 2014), and cognitive-behavioral models of PMS (Blake 1995), the specific aims of the therapy are to critically examine cultural constructions of femininity and PMS and how they impact women's premenstrual symptoms; to valorize women's expertise regarding their subjectivity and their bodies; to provide a non-pathologizing space for women to tell their story of PMS; to examine individual narrative constructions of PMS in the context of women's lives; to help women reframe their narrative to reduce distress; to identify and challenge negative cognitions associated with the body and with PMS; to examine perceptions of stress and of premenstrual symptoms to develop coping strategies for dealing with distress; and to encourage assertiveness and self-care throughout the cycle. This therapy has been found to be effective in significantly reducing premenstrual distress in a face to face oneto-one (Hunter et al. 2002) and couples format (Ussher and Perz 2017), as well as through self-help . In the face to face format, women discuss these issues with a therapist, over six to eight sessions, and engage in homework, such as doing things they enjoy, taking time-out, making note of the thoughts associated with premenstrual change and how these thoughts influence behavior, and practicing assertiveness. In the self-help format women are given information and exercises to practice at home.
Reevaluation of premenstrual embodiment is core to reduction in distress following this therapy (Ussher and Perz 2017;Ussher 2008a). In post-therapy interviews with women, we found marked reduction in reports of feeling "fat and ugly," or the use of animalistic metaphors. For example, women said "I don't feel bad about my body now. I couldn't care less about it now" and "I don't really have any negative feelings about my body anymore." This was associated with greater acceptance and understanding of embodied change, with less attention being paid to aspects of the body that had previously caused distress: What used to bother me before -bloating and not liking what I saw in the mirror, now doesn't seem to bother me as much, I do not dwell on it as much as I did before.
There were also accounts of awareness that such changes are normal and transitory, rather than a sign of pathology: "I know it's temporary and I know it's hormones and I know I'm bloated, so I'm not having as many issues with that." Awareness of cyclical changes facilitated self-care: "I'm very aware of it when it is in the calendar and I can actually work my way around that with the knowledge that I might need a couple of days of rest, that I didn't used to do, and now I do." The development of active coping skills to deal with premenstrual changes included self-talk to reduce premenstrual negative moods, avoidance of conflict, changing perceptions of premenstrual emotion, and recognition of premenstrual needs: "taking the time-out to recognise my own needs has been very useful." Active engagement in coping strategies which focused on "looking after my body" or "feeling better about my body" included taking time to rest, engage in activities women enjoyed, exercise, meditation, improved diet, and reduction in alcohol and caffeine, illustrated in the example below.
Physically I need a bit more rest is the main thing, um, so that's -that's a positive thing that it gives me that time to just slow down a bit and, um, have some time for myself. Like trying to do nice things for myself and do things that will make me feel good.
These self-care and coping strategies were reported to have a beneficial effect on women's moods, and their ability to control the experience and expression of negative emotion, resulting in significant reductions in premenstrual distress (Ussher and Perz 2017).
This form of psychological intervention does not remove premenstrual changes, but it can reduce and de-pathologize them, empower a woman to ask for appropriate support, and give her a greater sense of agency in relation to her body. This is no longer a passive docile body which requires medical management, but a body (and mind) which is positioned as being understood and accepted, potentially resulting in self-perceived "growth" through self-care: I am more sensitive around that period of time and I'm more susceptible to having old emotions and feelings that need to come up to leave me, but if I process it in the right way, it's a positive (and I've had) some growth out of it . . . I just think the self-care thing is a really big one for me, yeah.
Because of this, the majority of women reported that they felt confident that they could understand, and live with, their premenstrual changes, describing themselves as more "empowered," "energetic," and "creative" as a result. This is a movement away from the model of self-sacrificing femininity found to be associated with premenstrual distress (Ussher and Perz 2013a) to what has been described as a "mature model of care" (Pettersen 2012, 378), which acknowledges the importance of reciprocity and equality, and where self-care is be incorporated with care for others. conclUSion This form of women-centered psychological support can be effective in supporting women in the process of moving from an abject to an agentic subject position, without positioning her as needing to be managed, or her body as an unruly vessel that needs to be contained by experts (Ussher 2008a). 'PMS' is no longer positioned as an out of control illness, rather, as a label that makes sense of women's experience of psychological or embodied change in the premenstrual phase of the cycle (Ussher and Perz 2014). Women can resist the discursive positioning of the premenstrual woman as the epitomy of the monstrous feminine through positioning premenstrual emotions as "natural" or a reflection of "true feelings" about domestic, relationship or work issues, and embodied changes as something that can be understood and tolerated. This adoption of a PMS as normal/natural discourse served to facilitate women adopting an agentic position in relation to coping, through avoidance of stress and conflict, care of the self, and escaping relational demands and responsibilities (Ussher and Perz 2014). It can also function to engage partners in support, or facilitation of a woman's self-care (Ussher and Perz 2017). The body is central to this resistance of the monstrous feminine, as women can accept and acknowledge embodied change and psychological vulnerability, and even maintain the self-positioning as 'PMS sufferer,' without denigrating or pathologizing the body or the person. This is analogous to the "tight-rope talk" identified by Sue McKenzie-Mohr and Michelle Lafrance, wherein women construct themselves as both "agents and patients: both active and acted upon" (McKenzie-Mohr and Lafrance 2011, 64), enabling women to take credit for agency in coping and deflect blame for "having" PMS. McKenzie-Mohr and Lafrance (2011) describe this adoption of a "both/and" position as enabling the re-authoring of emancipatory counterstories, which serve to challenge the oversimplification of "either/or" binaries, where women are "agent or patient," "powerful or powerless"; or in the case of PMS, premenstrual sufferer or non-sufferer/coper. As Catrina Brown (2007, 275) has argued, this "both/and" position "honors women's agency and power while not minimizing the impact of oppressive social discourses and social relations." This allows us to both acknowledge the materiality and discursive construction of premenstrual distress, and women's agency and power in understanding and coping with premenstrual change. It also allows us to acknowledge the complexities in women adopting the subject position "PMS sufferer," which both evokes connotations of the monstrous feminine and makes meaning of women's distress, through legitimizing their experiences as 'real' and as something that may require support. The reproduction and resistance of discourses associated with premenstrual embodiment are thus overlapping, rather than being discrete and separate processes (Day et al. 2010), and offering women-centered therapy for 'PMS' is not a form of regulation, but a feminist endeavor acknowledging women's need for understanding and support.