Looks easy enough... but not for everyone
Bernie and I were returning from a men's group summer bush camp at Minto, south of Sydney, and were far from relaxed and fulfilled as we'd imagined we would be.
In fact, at Sydney Airport he was like the proverbial cat on a hot tin roof, and I shared the tension because I knew the reason.
Bernie is a paruretic and right then, emotionally and physically, the symptoms were torturing him.
We're talking Bashful Bladder Syndrome. In formal terms, as described in the Lancet, Bernie suffers urinary hesitancy, or paruresis, which is "an increase in micturition latency produced by the lack of privacy encountered in public restrooms". Or, in layman's terms, an inability to pee in the proximity of other people.
No one - neither psychologists nor the millions of sufferers - can draw a line between cause and effect. Bernie, newly turned 60, can remember a time when peeing in public was easy. That ended when, at about age eight, he was in a group in his native Canada when a girl challenged a boy, Bernie's mate, to prove, anatomically, that he was a boy. The lad wouldn't, but Bernie did.
It may have been a life-defining moment, because the boy who "didn't" told his mum, who mentioned it to Bernie's mum. Far worse, the boy's sister told the other kids in the street. Pretty soon it was all over Bernie's school, and a trip to the toilet for him brought on laughter and abuse.
Soon, he became a paruretic; though he wouldn't know the term for the next 30 years and believed through all that time he was a unique guardian of a guilty secret - an experience common to most sufferers.
A frequent overseas traveller, Bernie would flirt with dehydration before a flight. A couple of years ago, he even sought medical help in learning how to use a catheter to be able to urinate in aircraft toilets, though fortunately he hasn't had to use it.
The phobic person is anxious about other people seeing or hearing them urinating. Among other things, fear in toilets is induced by the proximity of others, by time constraints - someone waiting for them, an imminent travel departure, and by the motion of planes, trains and buses.
"Then," says Bernie, ahead of Australia's fourth paruresis workshop, which he's helping to promote, "there's secondary paruresis, which is worrying about it. That sustains it, locks it in. As pressure builds on the bladder, so does a sense of panic that you won't be able to void, that the back-flow will harm the kidneys. Some people fear they might die.
"Paruretics all tell the same story: that you've got yourself ready to let go, and something will go wrong. A cleaner will walk in, or someone enter the next cubicle, or a father comes in with a group of noisy children.
"That cuts you dead; you have to wait till they've gone and hope you will be able to urinate or, more likely, trek around in a state of high anxiety to find another toilet that's uninhabited."
At first blush this condition can seem quite comical - the stuff of schoolboy jokes for people who haven't experienced paruresis. But it doesn't require a leap of imagination to appreciate the devastating effect the phobia can have on the paruretic's relationships. They are the fathers who are always making excuses for not attending the football match or other outings where peeing is likely to take place in a less-than-private setting.
Bashful bladder is usually accompanied by loneliness, guilt, and depression. Of course, paruresis is not restricted to males, although males are more inclined to seek paruresis support groups.
Women are generally accorded more privacy in public toilets, and this may help, but female paruretics suffer equally.
But back to Bernie: his worst moments? "They were probably in the '70s when I lived in London and took a four-day bus tour on my own to Athens. Everywhere we stopped there were long toilet queues. On the way back, I was desperate to go and entered a police station on the Yugoslav border where I found a toilet. Trouble was, a fellow passenger joined me and asked if I wanted to go first - which, in my already panicking state, wrecked my chances of relieving my bladder. I hadn't peed in over 40 hours, would you believe?
"I just wanted him to disappear from the face of the Earth. I let him go first, but then found another toilet. I actually 'went', but then the door wouldn't open and I spent minutes banging on it, worried the bus would leave. Someone eventually let me out, but just rejoining the delayed passengers was humiliating."
Bernie, a former professional orchestral musician who now teaches music, recalls as a teen, about 15, going with a band to play at Ballarat's South Street competitions. "I remember the parent of another kid clicking his tongue in disapproval of me going into a toilet cubicle in place of doing the 'manly' thing and sharing the urinal."
But Bernie was terrified of going anywhere near a urinal.
"You build up this idea that you're not a real man because you can't stand up and pee in front of others."
Among thousands of pinpricking confirmations of that message was the taunt of a guard as Bernie jumped off a train stopping briefly at a country station between Sydney and Melbourne to use the loo. "Get back on the train! What's the matter with you? You ought to grow up!" he shouted.
Not surprisingly, Bernie, like many sufferers, has lived a largely solitary life. Crisis moments were a daily threat. Life was planned to avoid them. Paruresis has meant caution, anticipating 24 hours or a week ahead, and the erosion of spontaneity and confidence. Bernie's friends love him, but, from my point of view, too few have shared his intelligence, warmth and humour.
Perhaps the first breakthrough came when I showed him an Age article by sociologist-commentator Bettina Arndt, which, among other things, told the world that paruresis exists and revealed to Bernie he was not alone.
That article told of a 1975 study by two psychologists at the University of Idaho that found a quarter of the male college students they questioned reported difficulty "getting started" when using public urinals. But to that, Bernie says: "That's either a very mild form or not paruresis at all."
The internet age has unlocked many of the world's secrets. Computers have led to the setting up of paruresis support groups around the globe. People acknowledging occasional problems with hesitancy include Oprah Winfrey, Andrew Denton and US shock jock Howard Stern. In fact, recent studies show that about 7 per cent of the public may suffer from this social anxiety disorder to some extent.
Having consulted many therapists, Bernie began to beat his nemesis five years ago when, attending a personal growth group, a female participant suggested he check for an internet site, which turned out to be http://www.paruresis.org/
It was the key he'd sought for a lifetime. The site was the voice to the world of the International Paruresis Association, co-founded by US academics Steven Soifer and Carl Robbins.
Meeting Soifer in Sydney in 2005 was epiphanous for Bernie, though by then he'd already begun making gains from following Soifer's "in vivo desensitising" approach to beating paruresis.
Through attending workshops in Sydney and Melbourne, both of which were led by Professor Soifer, Bernie met a score of fellow sufferers. By mutual collaboration, a support group now gathers monthly at shopping centres around Melbourne to follow a "graded desensitisation" program.
"Exposure", or desensitisation, as described in Soifer's book Shy Bladder Syndrome (New Harbinger Publications), a bible for paruresis sufferers, usually involves "fluid loading" on water, tea or coffee, and attempting to pee in a public toilet under a challenging, but manageable, circumstance.
At Australia-wide workshops, such as the one which will take place in Melbourne this month, a conference centre is hired. During the weekend, in a mutually supportive environment, people tell of their experiences, new developments are discussed, and desensitising takes place.
Participants write down a hierarchy of situations in which they would have trouble urinating; for example, peeing with someone waiting outside the room or toilet door. No one is obliged to go beyond their zone of comfort. There is camaraderie among sufferers and new friends are usually made. Just sharing this "guilty secret" with another person who understands is therapy to many.
Professor Soifer, a lecturer in social work at the University of Maryland, in Baltimore, and a "recovered paruretic", shares a genesis not unlike Bernie's. As a child Soifer had a teacher who, for whatever reason, called him a girl in front of his classmates. Visits to the loo then meant calls of "What're you doing in here, girl?"
Paruretics aren't without humour, and don't mind having a laugh about their problem. Bernie shows me a cartoon in one of his books on the subject. It depicts a closed toilet cubicle door with five security guards outside, guns drawn, one of them shouting: "Either piss or get out!"
"That," says Bernie, "is a neat capturing of what the condition means to many people."
If Soifer's approach was the key, the contents of the box it opened have been a revelation to more than just Bernie, my friend for 35 years. Recently he's begun a relationship with a lovely, younger woman, his first such tryst in two decades. And three weeks ago he touched me deliberately, on the arm, and offered me some advice - the first time he'd done either.
The fourth Australian paruresis workshop will be held in Melbourne from Friday April 27, to Sunday.
For details about the workshop and Melbourne support group visit: http://www.paruresis.org.au
* Bernie's name has been changed.
A WEE PROBLEM * The technical term is Paruresis, but it is often referred to as Pee-Shy, Shy-Bladder or Bashful Bladder. It describes people who find it difficult or impossible to urinate in the presence of others, whether at home or in public. It extends to people who have difficulty under the stress of time pressure, when being observed, when others are close by and might hear them, or when travelling on moving vehicles. * US studies suggest it affects, to different degrees, as many as 7 per cent of the population. * It affects men, women and children. * For diagnostic purposes, it is classified as a social phobia, but this does not mean the cause of paruresis is purely psychological. * Paruresis can be treated with a variety of approaches, including psychotherapy, medication, and support group work. Source: International Paruresis Association
Read the full article here: https://www.theage.com.au/news/in-depth/a-wee-problem/2007/04/17/1176696828604.html