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The Evolution of the Bathroom and the Implications for Paruresis

How modern man (and woman) deal with the problem of human elimination has shown much variation across time, civilizations, and religions. The only reason it would even appear to be an issue is because we are social beings, and are concerned about how and what others think of us. Living in groups, the individual, to some degree, must conform to group norms in order to maintain his or her position within it.1

Moreover, the affluence of a society will shape the kinds of facilities that eventually develop. Initially, one would expect some collective facility, then perhaps several smaller facilities for subgroups or families, and finally individual toilet facilities in private dwellings. A key factor would also be the availability of water for disposal purposes.2

Early in the human species evolution, bathrooms were clearly unnecessary, since we wandered about without any permanent settlements, and used the outdoors and earth to relieve ourselves and cover our excrement – such as fields, rivers, and perhaps rock piles. Once we set some roots, however, and built dwellings, the need for facilities for the disposal of waste excrement was necessary. Consequently, primitive toilet facilities were created, first outside of any dwelling units, and then eventually moved indoors. Of course, just moving these early toilet facilities indoors wasn’t enough, since the odors could become overwhelming with time. So various methods were developed to deal with the situation.3

Several early human civilizations had remarkably sophisticated methods for dealing with human excrement. In 3000 B.C.E., Mesopotamia, the palace of Sargon I, king of Sumeria, had six primitive toilets in it. Also at this time, the Harapans of the Indus Valley had indoor toilets in private residences that fed into underground drains flowing into cesspools. Finally, the Minoan civilization, dating back to 2000 B.C.E., built the splendid Palace of Knossos, consisting of over 1400 rooms, had flush toilets by virtue of a sophisticated rainwater pipe system under the influence of gravity.4

It appears that the Egyptians had sit toilets, and seemed to use sand to cover excrement in the chamber below.5 The Romans, drawing on the Etruscans who had “built the largest sewer of ancient times,” created an elaborate drainage network for human waste. Wealthy Romans could afford to hook up their homes to this sewer system, while the less well to do had to rely on public bathrooms, which were a vast improvement over anything built before. In fact, by the fourth century C.E., over 140 public facilities were available.6

What did these public bathrooms look like? In some Tunisian ruins, the facilities had seats cut into marble ledges on three of four sides, with no dividers separating the seats. Water underneath carried the excrement away.7 One paid to use these toilets, and much socializing, politics, and business (and perhaps intrigue) was done here.8
Rome also pioneered the men’s public urinal, which was referred to as the “pissoir” or “Vespasienne.” Either simply out in the open or with a minimal degree of privacy, these devices collected the urine for the use as dye, which was sold by Emperor Vespasian to fatten his coffers.9 They were also a means to try and prevent the commoner from simply pissing in the stairwells of buildings.10

Yet, the plebeians(?), and probably most people at night, resorted to the chamber pot. Simple and effective, those filled with urine would be emptied in the morning by tossing it out the bedroom window onto the street below, a tradition that carried into the Middle Ages.11

As incredible as it may seem, almost a thousand years passed between the fall of the Roman Empire and the restoration of public (and to a large degree, private) toilet facilities in Europe, though Constantinople continued the Roman tradition of public sewage disposal.12

The Middle Ages, and the Crusades, raised renewed interest in toilet accommodations and public sanitation, as Crusaders came back and reported what they saw in the Arab world. Also during this period, castles were being constructed with “garderobes,” essentially privies with a couple of seats projecting off the side, with excrement falling into the moat below or down the sides of the castle into collectors below. Public toilets of any sort were few and far between.13 However, there is evidence that in 1214 C.E., Europe saw the beginning of the construction of manned public facilities in certain areas.14

The sixteenth century proved to be a major turning point for personal and public toilet development. In France in 1519, the Normandy government required toilets in every home. In India, the Mughal King Jehangir constructed public toilet facilities for over 100 people in the city of Alwar.15 Clearly, however, these were the exceptions, not the rule. As a study in contrasts, while the Indian palace had flush toilets made of marble, there wasn’t even running water in London during the 1700s. Most commoners, especially in Europe, relied on outdoor pit toilets and chamber pots; “visits to the toilet were also a family affair,” with enough seats for everyone!16

This brings us to a very important point. The whole idea of “privacy” in using the toilet is a very modern concept, with its origins in the 1800s.17 It is important to remember that the notion of “personal privacy” has evolved over the last couple of hundred years, and is directly tied to both economic prosperity and religious notions. As one observer has aptly stated: “One obviously has to have the conditions that permit modesty before a society can make modesty into an operable virtue.”18 What might seem incredible to us “moderns” today are pre-Enlightenment (and certainly pre-Victorian!) attitudes toward elimination. Quotes Kira: Kings, princes and even generals treated it [defecation and perhaps urination] as a throne at which audiences could be granted. Lord Portland, when Ambassador to the Court of Louis XIV, was deemed highly honored to be so received, and it was from this throne that Louis announced ex cathedra his coming marriage to Mme. De Maintenon.19

Several trends also seemed to be at play to change these old norms. On the one hand, it appears that rudeness and abuses certainly occurred in situations in which more than one person was in the privy, especially when there was no separation by gender.20 Also, with the Industrial Revolution and massive increases in urban populations, something had to be done to improve sanitation standards.

The year 1596 C.E. was a watershed; the Englishman J.D. Harrington “invented” the water closet, or WC.21 Of course, this was merely an improvement on an ancient design (the Palace of Knossos), the key difference being that the WC had moving parts. The WC, or toilet as it is referred to in the United States, was placed in a small room somewhere in the home. While decent people initially shunned its introduction, today it would be hard to imagine living without it, some saying it “marks man’s final ascent to civilization.”22 Believe it or not, it took a full 200 years before the WC became popular during the late 1700s. In the 1850s, Thomas Crapper, another Englishman, had the distinction of developing the toilet design that is still used today.23

The French led the way in other areas. In 1739 C.E., a Parisian restaurant, for the first time, provided separate facilities for the different sexes at a dance. Moreover, in 1824 C.E., the first public toilet facilities appeared in the French capital (?). England, in 1878 C.E., was the first to implement sanitation laws.24

There also appears to have been a tradition in which street vendors would, for a small fee, provide you with a cloak and bucket so that you could relieve yourself in public with a modicum of privacy. This also probably protected against thievery. There is documentation to show this occurred in Scotland in the 1700s, but still was occurring in places like Eastern Europe and part of Asia as late as the early twentieth century.25

Prior to the twentieth century, only the well to do had WC or flush toilets. The other classes had to make due with outdoor privies or “earth closets” (wooden seat and pail below) in a small room or in furniture, often referred to as a “potty chair.” Elaborate effort went into disguising these devices.26

The middle classes, especially in the cities, began to have toilets installed in their homes en masse beginning in the late 1800s and early 1900s. Functionality, not design, was the hallmark of the day. 27 It’s important to realize that another factor preventing mass installation of toilets, either personal or public ones, was the lack of sewage treatment, which only occurred for the first time in world history in 1889 C.E.28 Prior to this, despite the fact that the Romans had developed an underground sewage system many centuries ago, most sewage was disposed of in open gutters lining city streets!

We will now follow the private and public trends in bathroom evolution and design in the last century or so. Since our concern is mostly how these trends have impacted the development of Paruresis, we will focus more on the latter. However, the former is also important to understand the evolving attitudes concerning bathroom behavior and norms.

Regarding the private bathroom in the home, Kira writes: The three-fixture, five-by-seven foot bathroom, which is still the norm in the United States, dates approximately from the building boom of the early 1920s, when, for the first time, virtually all new residential construction, at least in urban areas, was required by law to include at the minimum a private bath for each dwelling unit.29

Amazingly, this remained the norm for about 40 years. It wasn’t until another housing construction boom in the 1960s that more than one bathroom per household became institutionalized. It wasn’t until the 1970s that people in the United States began treating the home bathroom as more than an essential, leading to larger bathrooms being built and more and more elaborate design ornamentation.30

As we have seen, the history of public toilets is pretty scanty. In some parts of the world, people still do their business wherever they are, whenever they want to. The two key factors influencing it have been public health concerns and the rise of large cities. Kira defines these structures as “one that is provided in the interest of public convenience, sanitation, and health in a communal location by, or on behalf of, a communal agency for use by anyone with need.”31

Why do people even need “public facilities” in the first place? One reason, of course, is not having access to a private bathroom (which in the case of today’s homeless population, is not uncommon at all). Another would be if one is not at home, that is, you are “caught short” either at work, socializing out, or traveling. These two circumstances have affected the design of public toilets to accommodate people in these situations.32

Once again, Paris led the way with the reintroduction of men’s public urinals in the 1840s, the first since Roman Emperor Vespasian’s time! Many, like in Roman times, were wide open; only some offered at least some privacy. The French also pioneered “fully enclosed kiosks” for women beginning in the 1860s. In the 1880s, water closets began to appear, which could be used by either gender. Also at this time, the streets of Paris boasted “les Water-Closets ambulants,” which were horse drawn carriages with several toilet compartments that cruised the main thoroughfares.”33

Historically, nothing seems to have stimulated the growth of public restroom facilities as much as the startling successful Crystal Palace Exhibition in England in 1851. Because of the vast number of people going to this event, the public restrooms not only had to be constructed on an unprecedented scale, but they had to meet the expectations of attendees and the public in general. About 800,000 people paid to visit the restrooms. Along with this, rail travel to the event and similar ones elsewhere provided the impetus to build public restrooms to accommodate passengers in the terminals, marking the real advent of such facilities.34

Met with initial skepticism, by the end of the nineteenth century, public restrooms were an accepted fact in the large cities of Europe and the United States. Initially clean and friendly, they have tended to deteriorate over the years. As commercial and retail businesses developed in the twentieth century, and building codes required them to have bathrooms for their customers, municipalities no longer felt required to provide them. Moreover, as new forms of transportation developed, such as the subway, car, and airplane, new forms of public (and private) restroom facilities were required. Finally, the growth of the state and federal park system, as well as the popularity of camping, raised issues of restroom design for the so-called “wilderness.”35

Let us look more carefully at three specific examples, all related to the mass production and consumption of the automobile. First, with the rise of the car as the favored means of transportation, there was a corresponding increase in the number of gas stations across the country. No longer able to simply get by with outdoor privies in the back, they needed to provide toilets for men and women. Moreover, in order to compete adequately with their rivals, “clean restrooms” became a must, especially since many motorists stopping at filling stations did so at least as much to make a pit stop as they did to buy gasoline.36

Secondly, as the federal interstate system developed, so did the need for public facilities along the highways. New York State pioneered the way here in 1968, setting up “comfort stations” on their interstate roads.37 Other states followed suit.
Finally, all of this travel by car helped the hotel and motel industry, too. What we accept as normal today only started in the early 1900s, when one hotel entrepreneur in New York State began advertising “A Room and a Bath for a Dollar and a Half.” The first to provide a full 5-by 7-foot bathroom, this standard continues today for both hotels and private homes.38

In thinking about the above history, it is important to understand current attitudes toward “territoriality and privacy.” While many, if not most of us, have positive or at least neutral feelings toward the bathrooms in our apartment or houses, when it comes to public restrooms, many of us have negative feelings towards them. This often has to do with their layout and/or how well they are or are not maintained. Says Kira: Most of our feelings about the body, sex, elimination, privacy, and cleanliness are magnified in this context of ‘publicness,’ for the fact of publicness, with its inevitable territorial violations and lost of privacy, increases our apprehensions.39

It is possible that we project this negativity onto what we find in public facilities, including the urinals, toilets, and perhaps even the strangers in there. If we fear the stranger, and suspect that our personal space may be violated, then the situation will not be conducive to our doing our business there, whether it is urination or defecation. And, even if we are neutral about our own bodily eliminations, we are certainly less so about others, especially if we see what is essentially supposed to be private or unseen.40

The well-known sociologist Erving Goffman speaks of “territories of the self,” which relates to what is perceived to be mine, in this case, in relation to personal space. If we have to create a temporary space that we perceive as ours in what is essentially a public facility, and this space becomes violated in some way, then we are likely to have a psychological reaction to it.41 In some cases, we would argue, this reaction is Paruresis.

Two key ideas here are “privacy-from” and “privacy-for.” The former arises most often in public facilities. We don’t want to be around others doing their business. So it becomes essential to protect ourselves from them. Again, Goffman is helpful here; he speaks of “civil inattention” as a way to create such protection. Says Kira: This device of scrupulously observed avoidance behavior is widely employed in many cultures and situations and demands that we avoid observing other people’s behavior and in particular . . . that we avoid making eye contact.42

Thus, in a public restroom, etiquette requires that men not make eye contact and certainly do not look at each other’s private parts. Also, spacing at urinals becomes an issue; for example, if there are three next to each other, and someone is at one end, the next person will go to the other end. Only if there isn’t a free urinal would someone go next to someone else. Otherwise, it may raise suspicions. Several exceptions exist to this general rule, in particular school and the military; institutions that attempt to enforce conformity by getting rid of privacy.43

“Privacy-for” is one of the guiding principles of home bathroom design. When extended to the public facilities design concerns, the following become important: “a discreet location; discreet identification; the use of visual barriers or compartments; [and] the use of masking sounds, most commonly piped in music.” Interestingly, there is much variation in this regard from culture to culture, especially in the area of visual protection. For example, European water closets are completely enclosed, affording maximum privacy to their temporary guests. In the United States, the standard design for stalls is sides and a door that start one foot above the floor and extend only 5 feet in total height.44 While Europeans, in general, detest U.S. public restroom designs, many people from the U.S. traveling abroad, especially paruretics, are delighted with European standards and consider them more “civilized.”

While social convention dictates that most people will generally ignore others in public restrooms, this is not very comforting to paruretics. Many simply avoid going in public at all costs. Women who do so can get into physical trouble; holding their urine was the cause of bladder infections for over half of the women in several studies. For the other gender, Kira notes: Lack of privacy, or more particularly, lack of privacy to the degree demanded by any given individual, can have unfortunate consequences. The most serious . . . is usually its inhibiting effect on elimination function, most often male urination. . . . Although it may strike some as surprising that this is still a problem . . . the advice columns of the newspapers carry letters asking about these problems with great regularity.45

As if all of what we have discussed so far wasn’t enough, there are other factors that affect people’s attitudes toward urination and defecation. For some, there may be a conscious or unconscious association of these activities, primarily urination, with sex, since the same organ, at least visibly, serves the same function. Moreover, there may be deep-seated “moral taboos” about keeping our genitals covered and not touching them in public, both of which are violated in public restroom situations. Finally, it seems that both men and women generally experience discomfort in making noise while eliminating, especially if others are around to hear them.46

There appears to be huge differences between cultures in elimination positions, especially regarding urination. What we found most startling is that the respective urination positions for men and women that we take for granted in modern society appear to at least historically been reversed! For example, Herodotus claimed that in Egypt, “women stand erect to make water, the men stoop.” In Ireland, “the men discharge their urine sitting; the women standing.” Among Muslims, at least historically, both genders “squat to defecate and urinate.” And European women, until quite recently, would often stand up to urinate, as their clothing almost dictated that position, and they could do so quite discreetly. Finally, many women today, because of the lack of cleanliness in public facilities, will not sit on the toilet seat to urinate, and instead either hover or stand up. Lest anyone think that men, at least in Western society, feel comfortable sitting down to urinate, all we have to do is recall that when President Lyndon Johnson heard that someone in his Administration was dovish on the Vietnam war, he reputedly said: “Hell, he has to squat to piss!”47 We can now better understand how certain issues come together for paruretics. As Kira comments: Since the entire sex-elimination amalgam is something we tend to think of as “dirty” and something to be somewhat ashamed of, we also tend to want to hide and disguise our involvement with it; in other words, we seek privacy for it . . . [and] we resort to all sorts of stratagems to avoid anyone’s knowing where we are or what we are about.48

The desire for modesty and some degree of privacy seem normal when it comes to something as private as personal elimination. While Kira feels that this desire, if taken to the extreme (that is, wanting complete privacy) can create a problem in that people may not be able to eliminate without these cues,49 from our point of view what is viewed as normal or not normal is far from clear. For example, Kira states that many have difficulty providing urine samples in a doctor’s office without sufficient privacy.50

At least one urologist has told us that at least one third of his patients cannot provide one on demand. So, what is wrong in such a situation? Clearly, insufficient privacy. Furthermore, even Kira says that one survey indicates that more than half will stop either temporarily or for the duration their elimination activities if someone else is in too close proximity either at home or in a public restroom.51

The need for privacy, then, seems to be important to many men and women when it comes to elimination functions. At least three levels of privacy can be discerned: (1) privacy of being heard but not seen, (2) privacy of not being seen or heard, and (3) privacy of not being, seen, heard, or sensed – in other words, other people should not even be aware of one’s whereabouts or action. It is probably fair to say, however, that these categories generally represent degrees of tolerable privacy rather than degrees of desired privacy, in the sense that, given a choice, most people would, for these purposes, tend to pick maximum privacy. The degree of tolerable privacy varies enormously, depending on the activity and the particular individual (emphasis ours).52

It would seem that those who are most “negative or apprehensive” about “disgusting” things like elimination would have the most difficulty with others around, and thereby require the most privacy for it.53 While this may be a psychological fact for some, it seems that several other factors, both social and environmental, come into play too. Interestingly, the home bathroom is the only “off-bounds” space in most homes, and thus the only place people can have total privacy for whatever needs (positive or negative) they have. The privacy afforded by the bathroom at home serves another function: reducing our shame and embarrassment while engaged in a private activity. While this may be a current “cultural norm” (recall that even in the recent past, privacy for anything, including elimination, was virtually non-existent), it is almost universally accepted today.54

The puritanical roots of our Anglo-Saxon culture may partially explain our fastidiousness around not only privacy in the bathroom, but gender specific public toilets.55 It seems that for a period of time in the liberal 1960s and early 1970s, several countries, such as England, France, Italy and Japan, had no such compunctions, and unisex public facilities were commonplace. This may still be somewhat true today, but our impression is that many countries are moving toward the more conservative moral (and political) standards of the United States.

Public restrooms in many places leave something to be desired. Many, it seems, provide “unbelievably minimal, cramped, and filthy facilities.” One survey of over 500 facilities in New York City in the early 1970s showed that about 70 percent of them had something wrong with them. And an American Automobile Association (AAA) survey around the same time indicated that “dirty rest rooms” came in second on the complaint list.56

How are public restrooms in various establishments, whether bars, restaurants, train stations, interstate rest areas or airports, designed and built? What governs the number of urinals and/or toilets that are installed in these places?

It appears that various building codes — either state, county, or city — guide the number of urinal and/or toilet fixtures in any particular building. These codes, however, only minimally address design issues, and usually only regulate things such as spacing and height. The Americans with Disabilities Act (ADA) also governs the number of handicap accessible urinals and toilets that must be installed.

When a particular establishment puts out bids to construction firms for a contract, the primary concern at both ends governing the design of restrooms will be how much it costs. Thus, on the one hand, those paying to have public restrooms built will want to minimize costs, and those bidding on a potential contract will do likewise. Consequently, architects designing the plans will try and recommend the least expensive alternatives that will meet minimum code requirements.

Men, even those who aren’t paruretic, face several problems when it comes to elimination in a public urinal. Least among these are back splash; however, this is compounded when there are no dividers, and men “hug” the urinal to afford some form of privacy. Also, urinals are often spaced so close together that in a crowded situation, one is virtually touching the next person’s elbows. It’s estimated that at least another foot of space is needed between urinals in many men’s rooms. While Kira states “from the standpoint of privacy and of clearly defining the “territory” of each urinal, it would be desirable if dividers were incorporated between fixtures,”57 we would go much further than that. Categorically, we would state that all urinals must have dividers between them, preferably floor to ceiling ones that mostly or completely block out the sight of the person standing next to you. Moreover, the low bowl urinals should be discontinued.

For women, the problems are different. Since it appears that the “vast majority” of women don’t sit on the toilet seat anyway (fully 96 percent in a 1970s British survey), it would seem that a redesign of women’s toilets is in order. The basic concern is getting venereal disease, which can happen. There are several innovative designs that would allow women to be in the more comfortable “semi-sitting” or “hovering” position.58 One solution we would propose for both men’s and women’s public restrooms, particularly for paruretics, is having at least several fully enclosed water closets installed in every public facility, as is the custom in most European countries. This would afford almost complete privacy for the user, and go a long way toward helping paruretics overcome their avoidance of public restrooms.

As previously discussed, the worst offender when it comes to the lack of privacy for elimination arguably is the prison system. All individuality is stripped away, and open toilets are the norm. Moreover, humiliating random drug tests with someone watching you pee into a cup is commonplace.

1 Kira, A. The Bathroom. New York: Viking, 1976, pp. 5-6.
2 Kira, op. cit., pp. 6-7.
3 Pathak, B. History of Toilets, presented at the International Symposium on Public Toilets, Hong Kong, May 25-27, 1995. On-line at http: //www.sulabhtoiletmuseum.org/pg02.htm (9/11/1999), p. 1.
4 Horan, J. L. The Porcelain God: A Social History of the Toilet. Secaucus: Citadel Press, 1997, p. 35.
5 Newman, E. Going Abroad. St. Paul: Marlor Press, 1997, p. 90.
6 Horan, op. cit., pp. 11 – 13.
7 Newman, op. cit, p.90.
8 Horan, op. cit, p. 13.
9 Kira, op. cit., pp. 194-195.
10 Horan, op. cit., p. 16.
11 Ibid, pp. 14-15.
12 Newman, op. cit., p. 90.
13 Ibid, p. 91.
14 Pathak, op. cit., p. 1.
15 Ibid, p. 5.
16 Newman, op. cit., p. 91.
17 Ibid.
18 Kira, op. cit., p. 6.
19 Ibid.
20 Ibid, p. 7.
21 Pathak, op. cit., p. 1.
22 Horan, op. cit., p. 204.
23 Newman, op. cit., p. 92.
24 Pathak, op. cit., pp. 2, 5.
25 Kira, op. cit., p. 194.
26 Newman, op. cit., p. 92-93.
27 Kira, op. cit., p. 8.
28 Pathak, op. cit., p. 2.
29 Kira, op. cit., p. 8.
30 Ibid.
31 Ibid, p. 193 – 194
32 Ibid.
33 Ibid, p. 195.
34 Ibid.
35 Ibid, p. 196.
36 Ibid.
37 Ibid.
38 Ibid, p. 198.
39 Ibid, p. 200.
41 Ibid, p. 201.
42 Ibid, pp. 201-202.
43 Ibid, pp. 202-204.
44 Ibid, p. 204-205. Interestingly, there is an internet urinal game in which people can guess where to go given one of several different scenarios. Most are intuitive; some are not!
45 Ibid, p. 205.
46 Ibid, pp. 206-207.
47 Ibid, pp. 105-106.
48 Ibid, pp. 104-105.
49 Ibid, p. 107.
50 Ibid, p. 107.
51 Ibid.
52 Ibid, p. 110.
53 Ibid, p. 165.
54 Ibid, p. 164.
55 Ibid, p. 168.
56 Ibid, p. 203. One can see how strongly this runs by observing people’s behavior around single stall locked bathrooms: virtually no one will use an opposite gender toilet even if it is empty and there is a line for your own gendered one.
57 Ibid, pp. 212-214.
58 Ibid, p. 230.
59 Ibid, p. 232-237.



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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.