Not so fast, Don Draper.

On Wednesday, the city of Elk Grove, Calif., began discussions to ban smoking from rental apartments. Unsurprisingly, the California Apartment Association and the Rental Housing Association of Sacramento Valley are opposed to the smoker-repelling measure. The Sacramento County Tobacco Control Coalition, meanwhile, is urging the city to become the first in the county to enforce an apartment-smoking ban. Several complexes in Elk Grove already have privately issued residential smoking bans — bans that are echoed in apartment complexes and co-ops around the country.

But the possibility of making a smoking ban a city issue is a thorny issue, one that permeates the public and private sectors like a freshly lit Newport on wool fibers. Cigarette smoke unquestionably and unavoidably stinks. It’s also a bona fide health hazard, especially for the very young, the elderly and people with compromised immune systems. And it’s not like your neighbor’s smoke stays neatly in your neighbor’s two-bedroom. As local resident Mimi Dixon, who lives in a senior facility, told the city council recently, secondhand smoke “comes in through the walls, the plumbing, through the lighting. It comes through everywhere.”

As someone who’d prefer her own home not smell like an ’80s frat party, I’m not thrilled when the heady aroma of tobacco (or other smokable substances) wafts into my apartment. And if my building were to suddenly issue an all-points ban on smoking, it would bother me only to the extent that our awesome, eternally puffing super would probably have to move. But I was more aromatically offended when we had a neighbor who had cats and a penchant for never cleaning the litter box. True, secondhand cat box stink isn’t a health issue, but how serious a threat is a smoker when you’re not under the same roof?

Left to the needs and desires of individual landlords, co-operative shareholders and tenants, smoking bans can potentially raise the value of a property  and increase the quality of life for everybody. But when it becomes a city mandate about what you can do with a legal substance in your own home, it’s an encroachment on the privacy of everybody, not just smokers. And that shouldn’t make anybody feel like breathing easier.

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One of the first things you have to deal with when faced with a life-altering illness is the decision about whom you’re going to tell, and how. When I learned I had malignant melanoma a year and a half ago, I told my editor before I told my family. (OK, I was on a deadline at the time.) Two days later, I told the whole world in a cover story for Salon. Two months ago, Boing Boing writer Xeni Jardin live tweeted her first mammogram – and her stunning diagnosis of breast cancer – to thousands of followers. For some of us, the diagnosis is where we find our voice. For others that kind of candor isn’t an option, for either professional or personal reasons.

While a friend was going through breast cancer treatment a few years ago, few in our circle knew that her mother was facing it at the same time. Five years later, Ginger, a figure skating coach, says that “I knew if I told anyone, my students would immediately start looking for another coach.” Instead, she covered up surgery with a story of a vacation to Maine, and sandwiched months of afternoon chemo and radiation treatments in between early morning and evening coaching sessions – and weekends traveling with her team. “It took everything to get through it,” she says now. “There were times I was so exhausted I couldn’t see straight. A couple of times I had to leave the ice because I was so sick.” But she says she’s never regretted her choice to keep silent. On the contrary, sticking to her rigorous work schedule and maintaining the demeanor of health was “what got me through.”

In the midst of a health crisis, the routines of a career — the sense of purpose and obligation it provides — can provide motivation and escape, something that isn’t easy to pull off when everybody’s concerned about your condition. Chris, a doctoral student and teacher at an academic medical center, didn’t enjoy having his students popping in to check on him during his treatment after a lung transplant for his cystic fibrosis. He’s since switched his care to a different facility. Now that he’s no longer on oxygen – “when you can’t conceal a blessed thing” — he’s also discreet with his peers. “I don’t want people deciding for me what I’m able to do,” he says. “I’m pretty good at determining that for myself.” He knows first- and secondhand how damaging honesty can be. When his wife asked for a scheduling change around one of his procedures, her boss relieved her of her duties, telling her that “he’d decided she wouldn’t be able to handle her responsibilities.” Pretty bold of him to come out and say it. The ease with which employers can “restructure” or blame a termination on popular culprits “inconsistency” or “absenteeism” make it easy to conceal how often people with chronic conditions and their caretakers lose their jobs over them — and even harder to determine how great a role illness plays in hiring practices.

Thanks to our often punitive American healthcare system, the consequences of illness can be severe far beyond the illness itself. Linda, who was diagnosed with MS four years ago, says her friends know her condition but she rigorously keeps it from her co-workers. “It’s bad enough to live with this disease not knowing how it will affect me,” she says, “but I am terrified that it could also affect my employment prospects.” For Linda, like far too many of us in this country, “the thought of losing my job and thus my healthcare is probably my biggest nightmare.” The Patient Protection and Affordable Care Act doesn’t take full effect for another two years, when no one will be able to be denied coverage based on preexisting conditions. Currently, you can  apply for a “high risk pool” if you’ve been uninsured for six months.  That’s a lifetime for a person with a serious illness, and for those of us on ongoing treatments and drugs, an unfathomable expense.

There are other reasons beyond the fear of career repercussions for keeping illness a secret. Nobody wants to be viewed as an invalid, or the one who might be circling the drain. And as cancer blogger Katherine, who has metastatic breast cancer, says, “It’s often easier not to challenge people’s assumptions than to explain.” Linda agrees that “I am perfectly capable of working and living a mostly normal life. However, there is still an antiquated view of MS in our society, and many people automatically assume that once you are diagnosed, your next step is a wheelchair.” And Ginger notes that even in this day and age, when you can’t swing a cat without hitting a LIVESTRONG bracelet, “There’s such a death sentence that people put on cancer.” The reality of illness is that there are plenty of days when you’re going through the rigors of treatment and its side effects, that you just don’t want to be the official spokesperson and explainer for This Is What My Disease Looks Like.

Just as difficult as being pitied, though, is the risk of finding yourself scorned for a condition beyond your control. Bette, who has autoimmune disorders, says, “I’m very Type A, never miss a day of work or class or a deadline, even if that means having to go throw up in the bathroom in between meetings with clients. There’s a perception that people with autoimmune issues are weak, fragile, or delicate, which are characteristics I really try to avoid, especially as a woman. There’s also a ton of stigma about fibromyalgia. Someone in my office the other day actually made a comment about how so many women say they have fibro for sympathy, which strengthened my resolve to keep my conditions to myself. ” And Cheryl, who was diagnosed with Type 1 diabetes after an initial misdiagnosis of Type 2, says, “Many people think I ate my way to diabetes, since I’m overweight, but that’s really not the case. I feel like my food choices are always silently (and sometimes not silently) judged. Look at the backlash that Paula Deen suffered. My reaction to that controversy? How awful that another person has to have this disease, no matter how she got it. It also feels somewhat embarrassing to be ‘sick’ — like a personal failure that one of my organs doesn’t work properly.” Now, however, she says, “I decided to become more public about it,” because among other things, “I’d rather do a shot in the middle of a crowded restaurant than in some dirty bathroom stall.”

As Katherine advises, “Every individual will have their own reaction and coping mechanism” for dealing with long-term conditions and sudden, sharp reversals of fortune. We all grapple with the physical changes and scheduling nightmares, with balancing our privacy and our secrecy, with the desire to share and the longing to be seen as our healthiest, strongest selves. We know that when we say we have cancer or we have diabetes, we have cystic fibrosis or lupus we’re HIV-positive, that you will not look at us or treat us the same way ever again. We just don’t know whether we’ll be met with compassion or a pink slip, with support or with judgment. There’s so much about illness we can’t control. That’s why we care so much about the one thing we always still have power over:  the way we get to talk to you about it.

With “Contagion” making such a powerful impression, for several days news articles seemed to keep popping up about contagious disease and the conflict between religious beliefs and immunization. There was nothing new about the basics: All 50 states require some specific vaccinations for kids, yet all of them grant exemptions for medical reasons – say, for a child with cancer. Almost all of them grant religious exemptions. And twenty states allow exemptions for personal, moral, or other beliefs.

According to the February 15 edition of The Wall Street Journal, a number of pediatricians are dropping families from their practices when the parents refuse immunization for their kids. “In a study of Connecticut pediatricians published last year,” the paper reported, “some 30 percent of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21 percent reported discharging families for the same reason.” They add:

By comparison, in 2001 and 2006 about 6 percent of physicians said they “routinely” stopped working with families due to parents’ continued vaccine refusal and 16 percent “sometimes” dismissed them, according to surveys conducted then by the American Academy of Pediatrics.

But some parents still fear a link between vaccinations and autism, a possibility science has largely debunked. Some parents just want to be in charge of what’s put into their children’s bodies, as one West Virginia politician puts it. And some parents just don’t trust science, period — a few have even been known to fake religion to avoid vaccinating their kids. So there are many loopholes. But now seven states are considering legislation to make it even easier for mothers and fathers to spare their children from vaccinations, especially on religious grounds.

In Oregon, according to a story by Jennifer Anderson in The Portland Tribune, the number of kindergartners with religious exemptions is up from 3.7 percent to 5.6 percent in just four years, and continuing to rise. This has public health officials clicking their calculators and keeping their eye on what’s called “herd immunity.” A certain number of any population group needs to have been vaccinated — 80 percent for most diseases, 92 percent for whooping cough – to maintain the ability of the whole population — “the herd” — to resist the spread of a disease.

Ms. Anderson offers the example of what used to be called “the German measles” – rubella. All it takes are five unvaccinated kids in a class of 25 for the herd immunity to break down, creating an opportunity for the disease to spread to younger siblings and other medically vulnerable people who can’t be vaccinated. If you were traveling to Europe between 2009 and 2011, you may remember warnings about the huge outbreak of measles there, brought on by a failure “to vaccinate susceptible populations.”

Here in the United States, several recent outbreaks of measles have been traced to pockets of unvaccinated children in states that allow personal belief exemptions. The Reuters news service recently reported 13 confirmed cases of measles in central Indiana. Two of them were people who showed up to party two days before the Super Bowl in Indianapolis. Patriots and Giants fans back east were alerted. So far, no news is good news.

But this is serious business, made more so by complacency. Older generations remember when measles killed up to 500 people a year before we started vaccinating against them in 1963. The great flu pandemic of 1918 killed ten times more Americans than died in the Great World War that ended that year and took the lives of as many as forty million globally. Our generation was also stalked by small pox, polio, and whooping cough before there were vaccinations.

In a country where few remember those diseases, it’s easy to think, “What’s to worry?” But as the movie “Contagion” so forcefully and hauntingly reminds us, the earth is now flat. Seven billion people live on it, and our human herd moves on a conveyer belt of perpetual mobility, so that a virus can travel as swiftly as a voice from one cell phone to another.

When and if a contagion strikes, we can’t count on divine intervention to spare us. That’s when you want a darn good scientist in a research lab. We’ll need all the help we can get from knowledge and her offspring.

Doctors and psychiatrists at work on the newest version of the Diagnostic Manual of Mental Disorders — the American Psychiatric Association’s bible for mental-health professionals — describe this confluence of symptoms as Premenstrual Dysphoric Disorder (PMDD). The revised version of the DSM, just the fourth new edition in 52 years, will be published next year.

Since 1987, PMDD has lingered in the ghetto of the DSM: the appendix pages where proposed diagnoses are deemed in need of “further study.” But right now, it appears as though PMDD will ascend in the ranks from a hypothetical ailment to illness to become a full-blown depressive disorder; taking a place alongside Major Depression and Bi-Polar Depression. The upgrade in status — which will be determined in the next several months — has become the latest flash point in an ongoing controversy between psychiatrists, academics, activists, pharmaceutical giants and women who insist they suffer from the disease, as well as doctors and women who refute the existence of PMDD all together.

PMDD is not just PMS, says Dr. Kimberly Yonkers, a professor at the Yale School of Medicine and Psychiatry. “It’s more complicated than that,” she says. “It involves emotional symptoms … Women with PMDD have significant impairment,” she adds, that can interfere with going to work, school or being able to participate in a household.

Yonkers is a champion of PMDD research, and she also sits on the committee that will either greenlight or ax PMDD’s placement in the DSM.

It’s important because the DSM remains the medical doctrine that separates the sad from clinically depressed, the neurotics from the normals and, potentially, the bloated from those with a mood disorder. Besides practitioners and patients, another huge stakeholder in the debate is pharmaceutical companies. When a new diagnosis makes its way into the book, drug companies such as Pfizer and Eli Lilly set off to manufacture a drug to alleviate the symptoms. Or in the case of PMDD, they can just rebrand an old drug to do new tricks.

So what is PMDD? The current criteria being proposed for PMDD includes mood swings, marked irritability or anger or increased interpersonal conflicts, feelings of hopelessness, marked anxiety and decreased interest in usual activities. Also: a subjective sense of difficulty in concentration, lethargy, a marked change in appetite, insomnia, a subjective sense of being overwhelmed and other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain.

Those physical ailments are the most controversial of the new proposed criteria. Some argue this would shove physiological or gynecological issues into the psychiatric realm, scrambling a mind and body separation that keeps mental health issues discreet  from physiological ones. If the newest proposal makes it into the DSM a woman will need to have had five of the symptoms during the past year, including the physical ones.

The debate has created unlikely allies. Pharmaceutical companies are eager to provide new drugs to treat PMDD. In 1999, the year Prozac was set to expire, Eli Lilly, the manufacturer of Prozac, went to the Food and Drug Administration to seek approval for Prozac as a treatment for PMDD.

The FDA approved the patent extension (in contrast, the European counterpart to the FDA found there was not enough research to establish PMDD as a medical diagnosis because of fuzzy criteria and shoddy self-reporting on behalf of women who had to track their daily moods for two months straight). It is the only time the FDA has approved treatment for a diagnosis that has not been recognized by the American Psychiatric Association. Eli Lilly then repackaged Prozac as pink and purple gel capsules and rechristened it Sarafem.

This matters because once a patent expires, a doctor can write a prescription for Prozac and the patient can get a cheaper generic brand. However, in the case of a patent extension to treat a new specific illness, there is no generic option. So when a woman gets a prescription for Sarafem, she can only get Sarafem.

Sarafem ran advertisements directly to consumers on TV and in women’s magazines. One ad featured an ordinary-looking woman in plain clothes angrily trying to pull a grocery cart from a row. The tag line read: “Think it’s PMS? Think again … It could be PMDD.”  In the first six months Lilly reported $19 million in Sarafem prescriptions. By 2001, it had raked in $85 million, then sold the patent to Galen pharmaceutical company for $259 million.

PMDD skeptics argue that this debate is about selling drugs, not science.

“PMDD is an invented ‘mental illness,’” argues Dr. Paula J. Caplan, a research associate at the Du Bois Institute at Harvard University, and author of “They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal.”

Caplan, who chaired a DSM work committee during its fourth revision, said she was appalled not only by the aggressive lobbying done by Eli Lilly to push PMDD through the committee, but also how much hard cash the company put into the research and trial groups. Caplan and others contend that PMDD has too much overlap with other mood disorders, such as depression. Creating a new diagnosis, they fear, would mostly benefit big pharma and not suffering women. Caplan argues that women “learn to pathologize themselves, often ignoring the real causes of their upset,” such as a failing relationship, a history of abuse or depression.

Additionally, critics of PMDD believe that the diagnosis is just another way to medicalize the female experience. PMDD, it’s argued, plays into ancient notions of women as overly emotional and unpredictable and needing to be contained by forces other than themselves. From puberty to PMS to PMDD to pregnancy to postpartum depression to menopause, opponents argue that throughout history there has been a one-sided conversation between doctors and women about the female body.

Indeed, public medical authority on women’s health does not have a sterling track record. In the 1800s, when issues surrounding the luteal phase (the week before menses begin) of a woman’s menstrual cycle began to be documented, there’s been a ridiculous parade of treatments. Dr. William DeWees of University of Pennsylvania coined the expression “melancholies of menstruation” in 1843 and promoted the idea “that the uterus exerts a power over every body system.”

Through the 1900s, psychoanalysis became the main treatment for women who felt not only emotional distress but physical symptoms, such as breast tenderness, bloating, food cravings and headaches during their luteal phase. In 1931, Dr. Robert Frank championed medicinal treatments for women who suffered from what he called premenstrual tension and for the next 50 years women who sought treatment for pain and distress during their luteal phase were given diuretics, saline cathartics, caffeine, calcium, Vitamin B, antispasmodics, laxatives, enemas, alcohol tonics, and in severe cases hysterectomies.  Now the cure being proposed is antidepressants. Other psychotropic drugs such as Zoloft and Paxil have also gained approval by the FDA to treat the symptoms of PMDD.

In a 1997 study of 200-plus women who were diagnosed with PMDD, conducted by Yonkers, 60 percent of women said their symptoms improved when they were given the antidepressant Zoloft. This raises an obvious question: What if these women were just depressed already?

Caplan argues that women who self-diagnosis themselves as having bad PMS or PMDD are suffering from depression for internal or external reasons, not because their menstrual cycle is wonky. In an article from the Journal of Women and Therapy, Caplan cited the experiences of an obstetrician who treated women who complained of severe PMS :

Ian Tummon an obstetrician-gynecologist who has suggested  (Tummon & Kramer, 1994) that even the term “PMS” no longer be used, reported that when his women patients begin an office visit by saying, “Doctor, I have terrible PMS,” they never again mention PMS during the rest of the session. Instead, he wrote, they spend the whole time talking about the way their husbands abuse them or about their 14-year-old children who won’t come home at night. To label these women mentally disordered – and send the message that their problems are individual, psychological ones – hides the real, external sources of their trouble.

Then what to do with a problem like Elise? Elise is a graduate student, petite, blond, with a Brigitte Bardot pout. She has never been abused. Has thrived in a healthy relationship with a female partner. Doesn’t have kids or a household to manage. Yet for years, she was incapacitated for at least seven days out of the month.

“Right before my period I would get incredible fatigue and cramps that would cripple me,” she says. “I guess I wasn’t myself, because ‘myself’ isn’t usually in such terrible discomfort. So yeah, of course, I’m more irritable and easily overwhelmed.”

Elise was diagnosed with a mood disorder before she sought treatment for her menstrual distress. She takes Zoloft for her moods and birth control for her periods. She skips the row of sugar pills every month on her birth control packet, meaning she doesn’t get her period at all now. “Breast cancer runs in my family, and taking the birth control I’m on ups my rate for breast cancer but it’s a risk I have to take. Otherwise I’m essentially an invalid for seven to 10 days. For Elise, all the solutions have seemed imperfect.

Those in favor of PMDD being absorbed into the mood-disorder section of the DSM argue that the mood swings and irritability and depressive symptoms amount to a separate diagnosis from regular depression because it is linked to the menstrual cycle and only appears days before the uterine lining is shed and disappears days afterward. “The timing is exquisite,” says Dr. Jean Endicott, professor of clinical psychology at Columbia University’s College of Physicians and Surgeons. Endicott also worked with Yonkers on the 1997 study.

If PMDD were to make it into the DSM, it’s possible that women could have a bona fide medical excuse for missing work or school during those days. Women need to report distress, not just discomfort, to their doctors to be diagnosed under the proposed criteria. The treatment regime as it exists now is antidepressants, not pain killers, anti-psychotics or tranquilizers.

Historically, differences in the sexes have been used as a tool of oppression, there is no doubt of that. However, what if there is a difference between men and women when it comes to the way hormones affect their moods and bodies? Even if women are the only ones who can get diagnosed with PMDD, even if people call it sexist, does that make it less real?

“One of the things I find frustrating about modern feminist critique,” Elise says, “is that I’m expected to be tough no matter what my body deals me, otherwise I’m giving in to patriarchy. What if sometimes, I’m in pain and I can’t do it on my own. What has to happen to make that acceptable?”