A Few Notes on Paruresis

by Christopher J. McCullough, Ph.D – Author of Free to Pee
(This book is available from The IPA Store)

A woman called me many years ago and said she had not left her home in 20 years.  I told her 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, the criteria for determining whether one suffers from some problem comes from the individual experiencing it, not from outside sources such as 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 same situation considers it a severe disability and feels that his whole life is devalued by it.

Thus 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, it also reveals that attitude is not inherent in the behavior but is assigned by the individual involved.  It may not seem so because the meaning assigned to the behavior may be many years old.  It may seem unquestionably this or that.  Nevertheless, since the inability 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 meaning in itself.

People talk about whether psychotherapy is helpful or necessary in addressing the problem of paruresis; I, for one, have found that paruresis is a much more psychologically complex issue than one may at first think.  Moreover, I believe that 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 focused on self-esteem and confidence and included an emphasis on developing assertive communication.

In the many phobias I’ve worked with over the years, including fear of birds, snakes, bridges, clowns, telephones, and burning buildings, one element seems present in all of them: a feeling that the phobia-inducing object or situation has more power than that of the phobic.  By either reducing the power of the object/situation OR by increasing the power the client feels he or she possesses, the phobia is eliminated or reduced.  In regard to paruresis I believe that there is also a power/powerlessness relationship at the urinal; thus the psychotherapeutic focus in my work with clients with paruresis is to build or rebuild a sense of power in their interaction with others.  This is something that can be addressed in one’s general life, i.e., non-paruretic situations, which then, indirectly, improves the ability to urinate in public.

As a footnote, I do not use the term “paruretic” to describe a person with paruresis.  Although there may be some initial relief in discovering that a problem has a name and that others experience the same thing, beyond that it seems to me 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.

What is Paruresis?
Self-consciousness and Self-containment
Sketch of Factors that Contribute to Paruresis
Resistance to Recovery