John Goldie is a retired GP and medical educator.
Just suppose a 35-year-old woman enters the surgery.
She sits down confidently.
‘I’ve been reading about a new antidepressant that can help with the anger I feel around my PMS. I’ve talked it over with my husband and we think I should try it.’
Her certainty is striking, but it is not simply personal. She speaks fluently in the language of research, treatment options, and self-management — a vocabulary shaped by a culture that promises relief through optimisation. Lay knowledge and medical discourse increasingly intersect, making patients active participants in constructing illness narratives.1 The same biology will soon produce very different stories.
The anger she describes is carefully bounded: not rage but irritability; not conflict but disruption. It matters less for how it feels than for how it unsettles domestic calm. The implicit question is no longer what is happening? but how can this be fixed?
“… biology never speaks alone. It is interpreted through cultural scripts, personal histories, and the conditions in which symptoms arise.”
Her request carries moral weight. She presents as a responsible steward of her mental health, having done the reading and consulted her partner. In this context, declining medication risks appearing careless rather than reflective.
Medicalisation here is not imposed but co-produced, with the consultation becoming the place where an illness identity can be confirmed.2 What is gained in validation may be lost in curiosity.
Yet this readiness to medicalise distress sits within a long, gendered history in which women’s frustration has been pathologised under shifting labels — ‘nerves’, ‘hysteria’, ‘neurasthenia’ — and now PMS.3 Here, PMS functions less as a discrete diagnosis than as a cultural shorthand through which distress becomes medically legible.
Now imagine a second woman. Same age. Same biology.
She sits down cautiously.
‘I get really irritable before my period. I know I shouldn’t. My partner says I’m overreacting. I don’t want tablets — I just need to be less difficult.’
Where the first woman finds a diagnosis, this woman finds fault. Her irritability becomes a moral failure rather than a medical one. Cultural narratives shape how symptoms are interpreted, often as powerfully as physiology itself.4 The same experience that justified treatment in one consultation now demands restraint and apology. Her symptoms are embodied but also moralised.
A third woman arrives, late and faintly amused.
‘Every month, the week before my period, everything feels harder. Work piles up, the kids are wild, and I’m running on fumes. I’m not ill — I’m exhausted.’
Her account resists both medicalisation and self-reproach. Instead, she gestures toward the structural pressures of the ‘double burden’ — the often-invisible labour of managing paid work alongside emotional and domestic responsibility.5 From this perspective, irritability is not dysfunction but signal: a reasonable response to an unsustainable load. A prescription risks becoming a technological fix for a social problem.6
“Medicalisation can legitimise suffering, but it can also deflect attention from the conditions that produce it.”
Of course, real patients rarely inhabit these narratives so neatly. Most move between biological, moral, relational, and structural explanations — sometimes within the same consultation. Biology matters: hormonal fluctuations can shape mood and energy, and many women experience genuine physiological distress. But biology never speaks alone. It is interpreted through cultural scripts, personal histories, and the conditions in which symptoms arise.
For the clinician, the task is not to decide which story is ‘correct’, but to recognise how each has been made plausible — and at what cost. The doctor is not a neutral arbiter but a co-author of meaning. Their language, assumptions, and silences help determine whether a patient’s experience is framed as pathology, character flaw, or social strain.
In each case, the doctor’s role shifts — negotiator, de-stigmatiser, witness. What remains constant is their power to frame distress as illness, weakness, or reasonable response. Taken together, these women remind us that illness is never simply a biological fact. It is a narrative woven from personal experience, cultural expectation, and structural constraint. Medicalisation can legitimise suffering, but it can also deflect attention from the conditions that produce it.
Taken together, these women remind us that illness is never simply a biological fact. It is a negotiated narrative, shaped by experience, expectation, and constraint. Medicalisation can legitimise suffering, but it can also divert attention from the conditions that produce it.
In general practice, a request for medication may be less a demand for treatment than a quiet question: what kind of explanation will make this life bearable?
References
1. Conrad P, Barker K. The social construction of illness: key insights and policy implications. J Health Soc Behav 2010; 51 Suppl: S67–S79.
2. Conrad P. The medicalization of society: on the transformation of human conditions into treatable disorders. Baltimore, MD: Johns Hopkins University Press, 2007.
3. Ehrenreich B, English D. For her own good: 150 years of the experts’ advice to women. New York, NY: Doubleday, 1978.
4. Markens S. The problematic of “experience”: a political and cultural critique of PMS. Gender & Society 1996; 10(1): 42–58.
5. Griffin G. A dictionary of gender studies. Oxford: Oxford University Press, 2017.
6. Moen P. Women’s two roles: a contemporary dilemma. Westport, CT: Auburn House, 1992.
Featured photo by The Cleveland Museum of Art on Unsplash.
