Epistolary Form and Inclusive Creative Writing Practices in Pre-Menstrual Dysphoric Disorder (PMDD) Research

BY AMBER JANOWICZ AND DONNA MAZZA — Amber Janowicz's research project Epistles of the Body: Tracing Pre-Menstrual Dysphoric Disorder (PMDD) through Feminist Waves and Personal Narratives, comes after twenty-five years of medical misdiagnosis and two decades battling to reach her higher education goals. 

The project, under supervision by Donna Mazza, addresses the significant underrepresentation of women’s voices within PMDD through creative non-fiction in the epistolary form and presents perspectives on the condition which subvert jargon and medicalisation.

Her project highlights that individuals with PMDD experience extreme mental and physical distress and social impairment during the luteal phase of their menstrual cycle. They are at seven times greater risk of suicide and wait twelve to twenty years for a diagnosis (Osborn et al., 2020; Shalini et al., 2023). Understandably, this lack of early diagnosis and appropriate medical support creates significant barriers to academic success, as debilitating symptoms can severely compromise a student’s ability to attend classes, complete assignments, and participate in academic life. This was Janowicz’s experience of the condition.

Being the first in her family to finish high school and lacking family support, Janowicz already faced significant challenges when she began her higher education journey in 1994. In addition, her undiagnosed PMDD significantly affected her academic performance.

She excelled in tasks due in the first half of her menstrual cycle, but her performance declined during the luteal phase, often failing to submit assessments and not attending examinations. This led to a polarised academic record, characterised by either high achievements or failures, which were a reflection of timing rather than capability. 

Janowicz re-commenced tertiary study as an undergraduate arts student in 2017 combining majors in visual art and writing and it was immediately apparent that the work she produced in both disciplines was deeply engaged with themes around female identity and motherhood. She drew on her lived experience and undertook a conversation between the disciplines in her work. This was a very talented student with unrealised potential who deserved support and mentorship to complete her undergraduate degree, which she did in 2020 and was invited to speak at graduation:

After a suite of challenges and disasters, I abandoned my degree. I simply did not know how to seek the help or support I needed to get where I wanted to go. I went back three more times, but with a growing family and timetables that were not family friendly, everything seemed too far out of reach. I accepted that someone like me, from my background, just had too much baggage to succeed in higher education. (Janowicz, 2021)

The power of creative arts

Janowicz’s honours project works with the embodied knowledge gained from her PMDD experience. It draws a line from the ancient Greek concept of hysteria to today’s recognition of PMDD, demonstrating how deeply ingrained societal biases have pathologised women’s experiences for centuries (Showalter, 1993; Micale, 1995; North, 2015) and the persistent need to challenge those perspectives, which continue to influence approaches to menstrual disorders and help-seeking (Bobel, 2010). 

The choice of the epistolary form in Janowicz’s research is strategic, aiming to bridge the gap between the often clinical, detached discourse on PMDD and the deeply personal, subjective experiences of those who suffer from it, concurrently addressing the lack of first-hand narratives (Osborn et al, 2020).

The form is historically well recognised within feminist scholarship and women’s literature often exploring themes of identity and social constraint and emphasising the importance of women’s voices in shaping narratives of their own health, resistance, and self-discovery. By employing letters, Janowicz taps into a format that resonates with modern modes of communication, such as emails, text messages, and social media posts where personal stories are shared instantly across digital platforms, fostering community and understanding in ways reminiscent of historical letter exchanges and networks (Taylor, 2009). By paralleling contemporary digital communication, her approach ensures that the narrative of PMDD is accessible and resonant for other women. 

The incorporation of her lived experience with PMDD is a key strength of Janowicz’s research approach and an important component of her academic success. She considers visual art and creative writing played a key role in addressing the challenges posed by PMDD, as avenues of self-discovery. She is open about how exploring subjectivity through writing and art helped her to navigate struggles with identity and suicidal ideation and values the potential for these practices to provide support and empowerment for others facing similar challenges. 

As PMDD transcends cultural and social boundaries Janowicz’s objective is to disseminate awareness through personal narrative using accessible language devoid of medical jargon and complex scientific data. Earlier diagnosis could have facilitated better management of her condition and enhanced her personal success, but rather than focus on this Janowicz is using it as a springboard to generate creative works through her honours study which respond to the struggles and issues raised in her undergraduate study. Her research aims to further the recognition and support for individuals with PMDD, preventing the prolonged delays that she experienced in pursuing her academic and personal goals.

Excerpt from Janowicz’s Honours thesis: An epistle addressed to Charlotte Perkins Gilman, author of The Yellow Wallpaper

References

Bobel, C. (2010). New blood: Third-wave feminism and the politics of menstruation. Rutgers University Press. http://www.jstor.org.ezproxy.ecu.edu.au/stable/j.ctt5hj8bc

Janowicz, A. (2021, February). Graduate speech. Edith Cowan University. [speech].

Micale, M. S. (1995). Approaching hysteria: Disease and its interpretations. Princeton University Press. https://doi.org/10.2307/j.ctv8pzbz5

North, C. S. (2015). The classification of hysteria and related disorders: Historical and phenomenological considerations. Behav Sci (Basel), 5(4), 496-517. https://doi.org/10.3390/bs5040496

Osborn, E., Wittkowski, A., Brooks, J., Briggs, P. E., & O’Brien, P. S. (2020). Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation. BMC women’s health, 20, 1-15. 

Shalini, S. N., Yadav, N., Krishan, K., & Sandeep, G. (2023). Diagnostic validity of premenstrual dysphoric disorder: revisited. Frontiers in Global Women’s Health, 4. http://dx.doi.org/10.3389/fgwh.2023.1181583

Showalter, E., Gilman, S. L., King, H., Porter, R., & Rousseau, G. S. (1993). Hysteria, feminism, and gender. In Hysteria Beyond Freud (1 ed., pp. 286-344). University of California Press. https://doi.org/10.2307/jj.13167887.7

Taylor, A. (2009). Dear daughter: Popular feminism, the epistolary form and the limits of generational rhetoric. Australian Literary Studies, 24.


Amber Janowicz is an emerging writer who earned her BA in Literature & Writing and Visual Art from ECU in 2020, where she was the graduate speaker. Amber is completing her honours on personal narrative and the epistolary form and has forthcoming work in Follow the Salt (Night Parrot Press, 2025).

Associate Professor Donna Mazza’s novel Fauna (Allen & Unwin, 2020), was a finalist for Aurealis Best Science Fiction novel, and The Albanian (Fremantle Press, 2007) won the TAG Hungerford Award. Her work is in Westerly, Overland, New Australian Fiction, Antipodes, the little journal, Indian Quarterly, Southerly and The Conversation. Donna is Associate Professor at Edith Cowan University where she coordinates postgraduate Creative Writing and supervises doctoral students.

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