Do estrogen fluctuations cause extreme challenges to women’s mental health? It seems that they do. But can they also trigger mystical experiences? If so, why? And how do we tell the difference?
Disclaimer: This blog focuses on cisgender women, as the Lisa Miller article (below) focuses on cisgender women. I am not sure what research has been done regarding the mental health impacts of menopausal-type estrogen fluctuations on transgender and non-binary people. I’ll be on the lookout for that.
Menopause: A Walk on The Wild Side
On December 21st, 2018, The Cut published an article by Lisa Miller titled “Listening to Estrogen–Hormones have always been a third rail in female mental health. They may also be a skeleton key.” Yesterday a sexologist colleague shared this article via Facebook.
I read this article and found it personally significant, and not just for the Solstice publication date. My own experiences with hormone fluctuations during pregnancy and menopause were deeply unsettling. Pregnancy was like a mind fuzz with a metallic taste–literally–and menopause was a quiet riot of thoughts and feelings, impulsive decisions, and a desperate need to reinvent myself (again). It didn’t help that at the same time, my youngest was entering adolescence and my oldest kid was having a second puberty, via transition and testosterone. The youngest was throwing knives at the floor and using his airsoft gun indoors on the antique bed that his father had lovingly refinished for him (no, he wasn’t allowed to do this!). And the oldest? Well… let’s just say a lot was going on for all of us.
I would say between the ages of 45 to 55 were the most intense. Aside from all kinds of emotions and angsty uncertainties and forbidden secret crushes on really ridiculous people, I was also having mystical experiences, including the “spontaneous combustion” I wrote about in the first month of this blog. There was also at least one waking vision and several vivid lucid dreams of great power and significance. Giving birth to a tiny translucent mo’o (Hawaiian lizard god)? Yep. That was one dream. Actually, I had two of those dreams, with a total of three lizard kidlets in all. (And who the heck was the father?!) Another immensely powerful dream, with the theme of “as above, so below,” inspired the tattoo on my right ankle.
And the wild thing was, sometimes other people would share an observation about me that seemed to confirm that “something real” and transformational was actually going on. There were times when I knew I was in rough waters, and I hung on to the mainstays of my life (children, house, a sense of family) but all the while these mainstays were also unraveling. I was also told later of a couple of incidents that I really do not remember, including one where I scared my kids by threatening suicide. Holy shit, Batman!
Mostly though, I don’t think I was potentially harmful to myself or others. I wasn’t drinking or doing drugs. I still got the children fed and off to school. I kept the books for the family business. Menopause was also when I went back to school to study sexology and hypnosis and started my career. I joke now that all those initials after my name is how I spell “mid-life crisis.” It’s true.
Given the above, I do consider that I was mostly sane (functional) during this period (though not always making the right decisions). And yet I was constantly “trying to hang on to myself” — whoever that was. And I wanted very much to know if my mystical experiences were valid and valuable. The only thing I could do was to consider them as valuable and see where that took me.
Menopause and Mental Illness
But let’s get back to the impact of menopause itself, and the fluctuations of estrogen. Lisa Miller’s article recounts several stories of women who went completely bonkers just before and during menopause: hearing voices, becoming dangerously delusional, and even “psychotic, catatonic, and suicidal.”
Here are four key paragraphs from Miller’s article. Hearken to the fourth one, in particular.
[Begin Quote] Youth has been a diagnostic criterion for schizophrenia for a hundred years, including within the pages of the DSM, where schizophrenia has sometimes included an age limit: As recently as the 1980s, a person could not be tagged schizophrenic if he or she was older than 40. Some clinics targeting early intervention have cutoff ages as young as 24.
But schizophrenia does not neatly comply with that simplistic understanding. In the early 1990s, three British psychiatrists, curious about why men with schizophrenia had their first psychotic episode so much earlier than women, took a look at the voluminous diagnostic records in doctors’ offices and hospitals in one populous London neighborhood covering a period of 20 years. They found something astonishing: a demonstrable “second peak” of first-onset schizophrenia after 45. These patients were predominantly female.
These older patients compose just a fraction of the total number. About one percent of people worldwide receive a schizophrenia diagnosis, and almost 20 percent of them are diagnosed for the first time after the age of 45. But the data suggested a deeply embedded bias in the way doctors had thought about schizophrenia for a century, overlooking the middle-aged women who came to them with psychotic symptoms, refusing to believe they could have schizophrenia because the official classifications, and medical tradition, excluded them. In their view, “madness” associated with “the change of life” was not madness at all — not a serious affliction to be taken seriously — but a women’s malady to be treated with bleeding and leeches, herbs and ointments, drugs, alcohol, and the desiccated and powdered ovaries of farm animals. Committed to American asylums in the late-19th century, women with mysterious symptoms were labeled “insane from suppressed menses.” And a whole ecosystem of diagnosis and treatment failed to grow.
There is, to be sure, genuine tragedy in lost human potential at a young age. But it is also tragic for a woman to become mentally ill in the middle of her life, at a time when she has, if she’s been lucky, built a universe — a family, a job, friendships, a network of responsibilities and dependencies erected on the assumption of stability. She might have adolescent children and aging parents, professional duties and bills to pay. She might have a classroom of students; she might be the mortgage broker helping a family keep ownership of their home or the doctor advising on a chemotherapy plan. [End Quote]
The article continues to discuss and make a case for “the estrogen hypothesis,” the role that estrogen may play in modulating psychosis, based on the work of Mary and Philip Seeman, and others. Mary Seeman first published this hypothesis in 1981. (And the general public is only now hearing about it? Argh!) A few researchers have paid attention though. Miller writes:
“In 2009, an Australian psychiatrist named Jayashri Kulkarni began publishing the results of extraordinary experiments that took the estrogen hypothesis to the next step. If fluctuations in estrogen exacerbated psychosis, then shouldn’t infusions of estrogen — supplemental hormones — regulate and ameliorate it.”
Kuklarni’s results were positive and encouraging. But U.S. physicians and psychiatrists are slow to catch on. Health care providers are still talking women out of hormone replacement therapy.
There is so much more to this article, which was also published in the December 24, 2018, issue of New York Magazine. I urge you to read it in its entirety, especially if you’re a woman approaching your own menopause.
Vulnerability or Capacity? What Can the Grandmothers Tell Us?
Now I want to swing this topic back around to an almost anthropological context and ask why human females would be the butt of what seems to be a cruel hormonal joke? Why would this destabilizing influence evolve, seemingly designed to wham women upside the head at the end of their reproductive lives? I tend to believe that most of what evolves in creatures is or was once useful and even humans are no exception. So why this?
I believe that a lot of the “cruelty” of this predicament is cultural and social. Miller ends her article with a quote from “Janet,” one of the women she interviewed:
“And I think there is knowledge out there, but I think it’s old, ancient knowledge that has been lost to the generations through the rapid, rapid changes — I’m talking about the past 50 years — and explosions in population. We don’t live the way we used to. We used to live tribally. The tribes could always share. There was a huge close-knit community that could share. I know what we need. I don’t know how to get it, but I know what we need: We need people who understand what is happening to us to sit down with us and explain it.”
I think Janet is right. And I’ll add this: in the not too distant past a lot of women did not live past their childbearing years. In fact, a lot of women died in the middle of them. In many cultures, the women who reached the age of grandmothers were respected as carriers of unique wisdom. Could it be that menopausal fluctuations of estrogen sometimes act (are “supposed” to act?) as another form of natural entheogen or as a catalyst to transcendence, at least in the right circumstances?
I am sixty-four now, nine years away now from riding the menopausal roller-coaster, yet still living in the wreckage of it (divorce and other estrangements). What if I’d been living in a society where the onset of menopause meant immediate intervention and nurturing from a group of elders who’d “been there, done that?” What if husbands and children understood and respected this special time? They understood how the wife and mother would be challenged by her potential transformation into a healer or a seer? What if they knew the red flags that meant special intervention was necessary? What if most menopausal mental breakdowns were averted by the understanding and care of an entire community? Perhaps not every woman would make it to the actual role and work of a seer or healer, but those who didn’t would not be scorned. They would still have a place in their family and their community. They would not be unloved for having gone through the ordeals. Grandmothers would still watch over them. And those who did come through their ordeal to take up the work would in turn look after the younger women coming up.
I really do need to re-read Barbara Tedlock’s The Woman in the Shaman’s Body (2005, Bantam). I need and want more multicultural information about the relationships of menopause and aging to such things as shamanic practices, healing, the working of magic, and so on. I sense a quest. From now on, I’ll be investigating this as I am so many other things, including trying to find information that is not strictly focused on cisgender women.
And so I sit here, in my Baba Yaga phase, a solitary practitioner of this, that, and the other thing, making offerings to gods and talking to plants and ancestors. I’ve come out the other side, not undamaged, but not wholly wrecked either.
Given the above, will I call my doctor now to ask about hormone replacement therapy? Yes, I certainly will, assuming there are some benefits at this age. I don’t feel HRT will negate what I’ve already experienced and learned. I think it will help me be more comfortable in my body as I move through the rest of my life in this cold, cruel society.
You’ll hear more from me on this.