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International Paruresis Association PO Box 65111 1-800-247-3864
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A Few Notes on Paruresis - by Christopher J. McCullough,
Ph.D - Author of Free to Pee What
is Paruresis? A woman called me many years ago and said she had not left her home in 20 years. I told her that that was interesting but why was she calling me? "Well," she said, "I want to go out." "Oh, I see, then perhaps I can help." The point is, that the criteria for determining whether one suffers from some problem comes from the experiencing individual and not external ones, e.g., psychological diagnosis or therapists, friends or family's opinion. For example, there are people who cannot urinate at a urinal under any circumstances but can do so using the stall. They do not consider this a problem. Another person with the exact situation considers it a severe disability and feels that his whole life is devalued by it. So, there is this relationship between the objective facts, i.e., the degree of freedom in urinating environments, and, the attitude one has toward it; what I call "Secondary Paruresis." Further, not only does attitude play a role in defining whether or not one suffers from a disability but, it reveals the fact that that attitude is not inherent in the behavior but is assigned by the individual involved. It may not seem so because the meaning one assigned to it may have been made many years ago. It may seem unquestionably this or that. Since not being able to urinate in the presence or anticipated presence of others means different things to different people, it is not possible to claim that it has any inherent meaning in itself. There are discussions about whether psychotherapy is helpful or necessary in addressing this issue but in regard to Secondary Paruresis I think there is a stronger indication that something of importance is being on with some individuals in which paruresis is a symptom. I, for one, have found that paruesis is a much more psychologically complex issue than one may, at first, think. I believe treating paruresis as a problem rather than a symptom of a problem limits recovery potential. I have two clients who describe themselves as recovered who did little to no behavioral desensitization or other symptomatic treatments (e.g., medication). The work they did in therapy was focused on self-esteem/confidence issues that included an emphasis on developing assertive communication. Having worked with many phobias over the years including fear of birds, snakes, bridges, clowns, telephones, burned buildings etc., one element seems present in all of them: A feeling that the phobic object or situation has more power than they have/feel. By either reducing the power of the object/situation OR by increasing the power one feels about themselves the phobia is eliminated or reduced. In regard to paruresis I believe that there is also a power/powerlessness relationship at the urinal so the psychotherapeutic focus in my work with clients with paruresis is to build or rebuild a since of power in their interaction with others. This is something that can be addresses in one's general life, i.e., non-paruretic situations, which then, indirectly, improves public urination. As a footnote, I do not use the term "paruretic" to describe a person with paruresis. I think initially one feels a certain relief in discovering that their issue has a name and that others experience the same thing. However, beyond that it seems to me that it can suggest that one's being is defined by the term. "I'm a paruretic," seems both undeserved and untrue. I don't know how much time you spend peeing (or not peeing) but the actual time involved is pretty small compared with everything else you do and everything else you are. I know it is more convenient to say paruretic than a person with paruresis but I think the distinction is important. In general I believe that descriptions of experience are less restrictive than labels. Labels offer a way of identifying an experience but can also create limits that in turn imprison. When any term is used in an attempt to describe human experience, it assumes there is some universal element or essence that exists in every instance in which the term applies. Yet, as with all labels, the universal essence of paruresis is elusive. For example, paruresis is considered by many to be a "Social Anxiety" or "Social Phobia." However, many who experience difficulty urinating in the presence of others are not anxious at all. Also, it seems clear that for many there is a pronounced or at least vague fear of negative evaluation from others (another characteristic of social anxiety) who may notice they are not urinating. Some, perhaps fewer in number, report they have no such concern. Some see a historical connection between childhood teasing and adult paruresis, some don't. Some see a connection between paruresis and penis issues, e.g. size, circumcised, uncircumcised etc. Then there is the fear of being thought homosexual or a fear of one's own homosexual feelings. The universal cause of paruresis is unclear and perhaps that is simply because the inability or difficulty of urinating before others can have many causes and contributing factors. This implies, of course, that no one treatment is effective for everyone. In spite of the fact that we all like a clearly defined problem with clearly defined solutions, the reality is that human experience does not conform to scientific principles. Each of us, at best, is an eccentric, a mysterious and complex and unique set of biological, psychological, social, environmental and historical experiences. One can never understand a "paruretic" only a unique individual who has difficulty urinating in certain circumstances. Beyond that definition, lies the individual self that deserves individual respect and care. I believe, and have seen in some of the clients I have worked with, that paruresis is an opportunity to address issues that greatly enhance the quality of their life. Working on paruresis is often difficult, boring and disruptive all of which seems unfair just to be able to pee! After all, one shouldn't have to be bothering with something like this. Resentment is understandable. Paruresis, seen as a symptom, however, holds the promise that by addressing the issues which underlie it, one can greatly enhance the quality of their life. The model of using paruresis as a vehicle for growth is much more palatable than the sterile efforts necessary just to be able to pee and nothing more. Self-consciousness and Self-containment At this point, I think that inappropriate or dysfunctional self-consciousness is the common factor that runs through all the variations of the problem. One may stumble as he/she walks by a group of people who seem to be staring at them. In this sense, paruresis is like "tripping." Some people can't have sex in front of their pet. It is not a particularly brilliant insight that self-consciousness is involved with paruresis but rather than trying not to be self-conscious, e.g., using multiplication tables, relaxation etc, I'm interested in exploring how one can, at will, achieve a sense of "self-containment." I recall a sports announcer describing Tiger Woods as a, "cocoon of concentration." A client once said that he experiences this most when he is flying an airplane. There is something happening at the urinal that seems to rob one of this safe containment. One could even see it as a boundary issue, a feeling of one's space being invaded. Even without the collateral issues of fear of criticism or anxiety etc., the mere presence of someone can cause a paralyzing self-consciousness. Psychologist Fritz Perls said that the cure for public speaking was to, "take back your own eyes." One is an anxious speaker when he/she goes outside him/herself and tries to see him/herself from the audiences view. In that process one has abandoned oneself and made oneself an object. The remedy is to stay "home" and focus on the audience so intently that you lose a sense of yourself, therefore, taking back your own eyes. An interviewer asked a baseball player how he could concentrate with all the noise from the crowd. He said, "what noise?" A client told me that Jack Nicklaus had the ability to connect with the crowd and then turn totally inward and focus on his next shot. When we become self-conscious we become an "object." When we are "at home" with ourselves we remain a subject that looks outward. But avoiding making ourselves into an object, as in the public speaking example, there is the challenge to remain so in the presence of others. When someone looks at us we are an object to them. Sartre talks about this as the "gaze." To not allow the gaze of another to turn you into an object requires that you hold on to your subjectivity, i.e., to keep the direction of consciousness from self to world rather than turned in on oneself. There are important implications of this idea regarding treatment for paruresis. Simply put, if one were to develop the capacity to establish a sense of self-containment in any situation it would eliminate the essential cause of freezing in paruretic situations. It would have the characteristic of being oblivious to the external world thus eliminating the possibility of self-consciousness. One of the good things about this insight is that the ability to achieve self-containment can be practicing anywhere, anytime unlike the awkward and time-consuming efforts in desensitizing to public restroom situations. You might first make a list of situations in your everyday life that could be used to practice this skill. Sketch of Factors that Contribute to Paruresis
Anyone with paruresis wants to be over it but there are factors in play that also resist recovery. One of the reasons that there is a part of us that may not want to be rid of it is because it has become a familiar part of who one is. Even something as negative as paruresis could leave one feeling a sense of an unfamiliar self. "I know myself as a paruretic, to lose that feels like losing a part of me," one might feel. The need for security by not changing is very human and we tend to hang onto what feels familiar. In this sense it is good to be aware that there is a battle with oneself as well as with paruresis per se. For example, it is not unusual for a chronically anxious client to report how anxious they became when they experienced a moment of relaxation. A second source of resistance to recovery is that the disability may have led to an association with others with the same problem, which one wishes to maintain. One gets a feeling of belonging and there is something very satisfying about sharing a common problem. To recovery is to lose membership in the group. Also there can be a feeling of guilt in recovery. An example is when two overweight people become friends; if one of them loses weight he/she may fear that the other person will feel abandoned/rejected. In order to avoid the guilt they maintain their obesity. Getting better while others don't may result in "survivors guilt." There can also be many other more sophisticated resistance factors having to do with unresolved family issues etc. The important point is that if you aren't aware of that part of you that resists recovery your progress will be more difficult. Random Thought: If peeing did not involve one's genitals, would anyone suffer with paruresis? If one urinated from the left index finger (point and shoot), would we have the IPA? Of course, if urinating employed the middle finger it would make, "giving someone the finger" a whole new meaning. Just a thought....
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Copyright 1999-2008 International Paruresis Association. WARNING AND DISCLAIMER: This website is NOT a substitute for medical or legal advice and does not constitute the practice of law, medicine, psychiatry, clinical psychology, clinical social work, or any other mental health profession. If you are having trouble urinating, you should always contact a physician since difficulty with voiding can be a symptom of a serious medical condition. We are a group of professional people and people who have suffered with paruresis. We have assembled a board and a board of advisors to help people cope with urinary dysfunction that has a psychological or social origin. On this website, we are NOT practicing medicine, psychiatry, clinical psychology, clinical social work or any other mental health profession. You should have your doctor evaluate your condition before diagnosing yourself, and seek the appropriate necessary mental health counseling if warranted. IPA, Inc. disclaims any and all legal liability whatsoever. |
