Emma Hardy lives with premenstrual dysphoric disorder (PMDD), a severe form of premenstrual illness that, as she describes it, “rears its head in the week or two before menstruation then goes away.” One week she might lie on her bedroom floor, unable to move, starting fights with her partner. The next she would return to work, seemingly fine, and completely oblivious to the person she had been days before. For Hardy, an Australian writer based in Naarm/Melbourne whose debut memoir Periodic Bitch was published by Allen & Unwin, the condition is chronic and recurring. “I am always in, or just out of, or about to enter the throes of my illness,” she writes. “It does not get better in any static sense.”
Hardy’s diagnostic journey began in earnest in the middle of 2020, when she was 27 and the world was in lockdown. She removed her birth control and kept a daily log of her moods and symptoms for three months. She saw GPs, gynaecologists, endocrinologists, psychologists and psychiatrists. Her diagnosis took only months — a period she describes as lucky. For those suffering the chronic pain of endometriosis, the original article notes, the average diagnosis time is six and a half years. In the UK, the picture is even starker. According to Endometriosis UK, the average wait now stands at nine years and four months, up from eight years in 2020, and for ethnically diverse communities it can stretch to 11 years. A substantial proportion of patients — up to 83% — have been told by healthcare practitioners that they were “making a fuss about nothing” or that their symptoms were “normal.” The charity is campaigning for governments across the UK to commit to reducing that average to one year or less by 2030.
Hardy continued to track her symptoms long after she needed to, still hoping that if she properly understood her illness she could “get through it and come out well.” But she came to a different realisation. “There was no cure for me: only ways to manage,” she writes. That recognition — that she was never going to “get better” in a conventional sense — forced her to confront the inadequacy of the stories we tell about illness.
The tyranny of the hero’s journey
In Western culture, the dominant narrative structure is the hero’s journey: a singular character is called to adventure, initially refuses, then accepts with the help of a mentor, overcomes challenges after false victories, and returns a hero. Many illness narratives follow the same arc. There is an inciting incident — someone gets sick. The person does not want to be sick. The illness is eventually accepted, bravely fought, and our hero either gets better or dies. This structure, Hardy argues, relies on closure and values transformation over endurance. “But it has nothing in common with how chronic illness actually plays out,” she writes.
Since releasing Periodic Bitch, Hardy says she is often asked how she is now. Each time she feels an overwhelming urge to neaten the narrative and say that she is good — to tell a hero’s story. “But my diagnosis was not a call to adventure,” she insists. For people living with chronic and recurring illnesses like hers, there is no neat recovery. “Through the narrow lens of the hero’s journey — they either get better, or they die — chronic illness quickly becomes terminal.” The question then becomes: how to tell a story about illness that doesn’t end in death or recovery, but allows for life with illness?
The tension between the conventional arc and the reality of long-term conditions is well documented. The sociologist Arthur Frank, in The Wounded Storyteller, describes “chaos narratives” where the reality of illness disrupts established self-stories. Chronic illness often defies traditional conventions of causality, progression and closure. Some scholars argue that the chaos can be expressed through non-linear or even non-narrative forms, or through structures such as radial narratives where pain serves as a central point. The brevity of the short story form, too, has been seen as particularly suited to conveying the uncertainties and lack of narrative closure that characterise chronic illness.
Hardy found a more resonant model in Jane Alison’s book on narrative patterns, Meander, Spiral, Explode. Alison describes how narrative patterns can follow shapes found in nature. The hero’s journey follows the pattern of an arc, or a wave. “There’s power in a wave, its sense of beginning, midpoint and end; no wonder we fall into it in stories,” Alison writes, before equating that structure to a male orgasm: “But something that swells and tautens until climax, then collapses? Bit masculo-sexual, no?” Hardy finds this both funny and transformative. There are many patterns beyond waves or arcs — meanders, explosions, cells, networks, fractals. She realised that just as her illness loops around, so can the stories she tells about it.
Finding new shapes for illness stories
One alternative Hardy highlights is the spiral. It is a pattern fit for recurring illnesses or looping obsessions — for stories told over years as the Earth spirals around the sun. “I think if a narrative arc is a male orgasm, a narrative spiral might be a female one: building, repeating, ongoing,” she writes. Alison’s work explores spirals alongside waves, meanders, radials and other natural forms as ways to create more vital and true narratives. For Hardy, the spiral allows room for patterns, repetitions, for looping back to the same moment only with new understanding.
This search for alternative narrative forms is not merely an academic exercise. Hardy’s memoir Periodic Bitch — which she describes as exploring menstruation, madness and monsters — questions the line between a mood and an illness. It touches on crime scenes, feminist horrors and the history of “hysterical illnesses.” Reviews of the book highlight its exploration of medical misogyny, the terror of the unknown, and the strangeness of living with a poorly understood chronic condition. The cultural construction of the “female monster” and the long-standing conflation of menstruation with monstrosity run beneath the surface of the text. Hardy’s work is part of a broader conversation about how the historical framing of female illnesses has led to misunderstanding, dismissal and stigma, which in turn contributes to the inadequacy of traditional linear illness narratives.
The diagnosis of PMDD itself remains fraught. There is no specific clinical test; a GP typically assesses physical and mental symptoms in relation to the menstrual cycle, often requiring a symptom diary kept for at least two months. PMDD was only included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013. Globally, around 1.6% of women and girls have symptomatic PMDD, though some estimates place the figure between 5% and 8% of menstruating women. The condition is caused by an abnormal reaction in the brain to the natural hormonal changes of oestrogen and progesterone. Symptoms can include extreme anxiety, depression, suicidal ideation, anger, irritability, mood swings, hopelessness, low energy, reduced interest in activities, difficulty concentrating, insomnia, and physical discomforts such as bloating, joint pain and headaches — enough to significantly impact work, relationships and social life.
For Hardy, the neat moral lessons of the hero’s journey do not help when her body will not re-enact that story. “A neat ending does not help me live my messy middle,” she writes. Instead, she wants to write herself a world in which illness narratives do not have to be neat or digestible, but can be messy and real. “I find hope in a spiral,” she says. “I am still here. The story continues. There is meaning, perhaps even pleasure, in that.”