In Trauma and Recovery, Judith Herman argues that even though women were critical to the development of modern psychoanalysis, our pain has been abandoned and ignored at every turn. The patient zero behind talk therapy was Anna O., a patient of the pioneering psychoanalyst Josef Breuer. She was critical to the understanding that trauma could spawn mental illness. Sigmund Freud was the first to hypothesize that female “hysteria” stemmed from childhood sexual assault, but he retracted his theory once he realized that it meant the ritzy neighborhood in Vienna in which he practiced was rife with sexual predators and child molesters.[1]
A hundred years later, our scientific community still attempts to brush women’s relationships to trauma under the rug. Until very recently, whenever PTSD researchers experimented with trauma in mice, they only used male mice. When they started trauma studies on female mice, however, they found that females responded to electric shocks very differently.[2] Whereas male mice froze up when shocked, female mice darted and tried to escape. This lack of scientific study on female bodies is significant because PTSD manifests differently in human males and females as well.
Symptomatically, men with PTSD are more likely to exhibit anger, paranoia, and an exaggerated startle response. Women are more likely to be avoidant and have mood and anxiety disorders. Women generally focus on regulating their emotions, while men focus on solving problems. Women often deal with stressful situations using a tend-and-befriend response, rather than men’s fight-or-flight response. Women generally seek more social support than men do, and they benefit more from psychotherapy. They also tend to lean more heavily on self-blame.[3]
But no one knows exactly why men and women experience PTSD differently.
Joe Andreano is a cognitive neuroscientist and instructor at Massachusetts General Hospital, who, among other things, studies the changes that happen in menstruating people’s brains during their cycles. “A lot of the time women at conferences will tell me that I’m very brave for doing this,” he confessed to me. “And then afterward I feel slightly threatened that they would view it that way. Like, what…what should I be afraid of?”
For the record, I think Andreano, as a man in science, handles his subject matter with a very well-balanced mixture of scientific objectivity, sympathy for the feminine experience, and antagonism at dude bros who make PMS jokes at conferences.
They make these jokes because Andreano has found in his neuroimaging studies that during the mid-luteal phase (the second half of the menstrual cycle after ovulation), we have higher levels of emotional arousal and more connectivity between emotion and memory. This finding is far more complicated than just “Bitches be PMSing!” This connectivity means that if we are unlucky enough to be abused during this time period, those abuses can lodge more deeply in our memories and become encoded in our brains. These memories are also more likely to encourage a negative memory bias, a tendency to return to these negative memories more than positive ones. Bottom line: We are more vulnerable to developing PTSD or depression if we experience trauma during a certain point in our cycles.
“But the amygdala is also involved in endocrine regulation and the regulation of stress responses, right?” Andreano explained to me. “So you’re not just going to be having this change in behavior or memory. You’re also going to have changes in the way that your body hormonally reacts to stress. And the stress hormone and sex hormone systems are very intimately connected. You do something to one, you’re going to influence the other. We perturb sex hormones, we perturb stress hormones, which then further perturbs sex hormones, and so on.”
“So it becomes a feedback loop,” I said, piecing things together.
“Right.”
It starts to make sense. Women are more vulnerable to trauma during certain parts of our cycles. Then that trauma makes women more vulnerable to unhealthy sex hormone changes. The facts bear it out. Children who experience trauma are more likely to hit puberty earlier. Again, women who experienced childhood trauma are 80 percent more likely to experience painful endometriosis.[4] They’re much more likely to develop premenstrual dysphoric disorder. More likely to develop fibroids.[5] It may affect fertility.[6] They’re at greater risk for postpartum depression[7] and depression in menopause.[8]
Fate had finally come knocking. I did not have to wait until I got older to experience the inflammation and health risks the books had warned me about. They were here.
* * *
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After I got my endometriosis diagnosis, I blubbered on the phone to my friend Jen. “I was just getting happy,” I told her. “I was just figuring it out. I was just healing. And if I have to go back on the NuvaRing, I know I’m going to get depressed. I know I’m going to go all the way back to square one.”
Because she is the most empathetic person I know, she started crying on the phone with me. “Oh, Steph,” she sighed, sniffling. “You’ve worked so hard. You’ve learned so much. Maybe it won’t be that bad.”
But it was that bad.
The NuvaRing did make me depressed—terribly so. It also gave me vulvodynia, which made me so sore I couldn’t even use tampons.
I went on Lexapro to offset my depression. It was the third SSRI I’d taken.
Throughout my life, people have wanted me to take meds because they assumed the drugs would “fix” me. After I went off Prozac in college because it made me foggy and unable to concentrate, one friend said not taking my medication meant I wasn’t “trying hard enough” and I didn’t really prioritize my mental health, so she couldn’t take care of me anymore.
A decade later, another friend, also tired of my constant complaining, said that going on an SSRI would make me “less selfish.” Samantha, my therapist at the time, said it was a bad idea. She said I needed to work through my problems, not numb them. But I didn’t want to be selfish, so I ignored her and went on Wellbutrin anyway. It exacerbated my panic attacks and made me manic. Luckily, I noticed that my resting heart rate had skyrocketed to more than one hundred beats per minute and immediately went off it.