I've had paruresis for so long that I can't even remember how it started. I have a vague memory of standing in line with some cub scouts when I was about seven and being under some kind of time pressure, which is followed by memories of standing in front of the school trough-urinal and not being able to do anything – much to my own bemusement. From then on, I've simply lived with it – hoping and expecting that it would gradually fade away in time as I became older and whatever experience had sparked it off faded even further into the distant past.
I was wrong of course. When I turned 29 at my last birthday the problem was as bad as ever. I'm not, and have never been, as critically affected as some people. I'd always been able to go in stalls, and sometimes even at urinals if there was no-one too close. But AP was affecting my life in a myriad of small ways, although I was largely in denial of the fact, because the problem seemed to be a 'given' which I was powerless to tackle. Therefore, I thought, my only choice was to live with it – to cope.
Here's a few ways in which it held me back: I remember the time I went sailing with my grandfather and drank lots of coke. I couldn't pee with him and his friend there, and almost burst by the time we got back to shore. Since then I've avoided toilet-less boat trips, even though I adore sailing. Take a dugout canoe up the Amazon? Sorry, I'm going to have to stay at home. I've also been involved in environmental protests in this country. How come I was the one who never got arrested? Because being locked up in one room with a load of people and no privacy was a prospect too horrible to contemplate. Most recently I did a research trip to China, and spent far too much time in a state of heightened anxiety trying to figure out clever ploys to get me some time out of sight and alone – vital in a country where everyone shits and pisses in unscreened holes in the ground.
Thank god that someone invented the Internet, and I found I was not alone. I think I laughed and cried when I first found the AP website, I was so relieved. At last I could get some perspective on the issue, and see how others had coped. Of course I was hoping for a miracle cure, but instead of that sent off for Chris McCullough's 'Free to Pee' self-help course. This languished in the back of a cupboard for at least six months before I got round to admitting to myself that the problem was seriously affecting my life. As well as the China trip, one of the last knocks was a throwaway remark by an Irish friend of mine when we were in the pub together. "Why do you always go into the cubicle?" he had leered at me when we were both in the toilet together, and he – of course – was standing at the urinal expecting a man-to-man bathroom chat.
So, at last, the decision was made. "I'm sick of being held back by this", I thought. "If I'm going to have to spend hours standing around in public toilets to at last be free of this thing, then so be it." I dusted down Dr. McCullough's book and began.
I can't emphasise strongly enough how difficult it was to take even this small step. The desensitisation strategy made obvious logical sense, but having to write down my personal 'hierarchy' on a piece of real paper – where someone else could plausibly find and read it – was the toughest time I've ever put pencil to paper. But I did it anyway, because I'd finally figured out that I had no choice. At the bottom of my hierarchy – the baseline – I wrote: 'Bowl urinal in corner, no barriers, no-one else using them, but people in room'. This was the level where I would be challenged, but I could reasonably expect to be able to go. At the top of my hierarchy – the thing I most wanted to achieve – I wrote: 'Using trough urinal next to someone'. This was something which seemed inconceivable to me. I'd never be able to do it. That was just the way I was.
It's worth mentioning at this point why desensitisation is really the only way to move forward. AP is a kind of social phobia, a learned behaviour where the unconscious impulses governing urination have got themselves in a mess, and various sphincters don't relax in the presence of other people. The point about desense is to start at a baseline where you can almost always succeed, keep practising until it becomes second nature, and then move onto something slightly more challenging. Success reinforces itself - it stands to reason (as does failure, which is why you have to move up the hierarchy gradually). In my case I wasn't graduating from stalls to urinals, which I understand presents a big barrier for some people – but even this should be surmountable if the steps are incremental enough. (Try moving from busy stalls to deserted urinals, for example, in an environment where you feel in control.)
So off I went, having selected my local gym as the public toilet where I felt most at ease and would draw least attention (this latter point being more paranoia than reality, of course). I tanked up with enormous amounts of fluid – although this isn't in Dr McCullough's programme, I found it was the key determinant with me early on – and by the time I arrived at the gym toilets I could hardly hold it together. There was someone using the wash basin, directly in line with the urinals, but I went anyway. Lo and behold, I could pee.
Next I had to prove to my mind that this wasn't a flukey one-off, and the only way to do that was to keep on doing it – over and over again. I went back to those gym toilets once or often even twice a day, and by the end of one month I could pee in the urinals even if someone else was also using one close by. I'd moved two steps up my personal hierarchy. I was making progress.
'Time to make things more interesting,' I thought the following week. (If you're wondering – yes, I work at home, which made all this much more convenient.) So I visited the commercial cinema in town, just at the busiest time before the 6.30 showings. To my surprise and horror, the big toilets were out of service, and only a little one upstairs was available. A man was at one of the two urinals, his kid waiting behind. I almost avoided ('avoided' means going to the stalls and avoiding the situation, hence, for me 'avoidant paruresis') but then thought 'f*** it' and stood next to the guy. And peed. Easily. I couldn't believe it, and almost burst out laughing.
'Maybe that was a fluke', my addled mind persisted. I knew the only way to prove it wrong was to truly learn the normality of this new behaviour. I could go to a urinal and I could pee. I could go to a urinal and I could pee. Now do it again. And again. And again. Until it becomes boring. Until it becomes normal.
It was still much easier if the need to go was urgent, and I'd drank a lot before. But within another month of this much of the anxiety had disappeared. I really didn't care how long it took, and I'd ceased to believe that other people around me cared either. No-one who doesn't have AP gives a shit, of course, what other people are doing at urinals (as long as they're not cottaging or something potentially threatening like that) but who said social phobias were logical? But at last my phobia was giving ground. I began to go into public toilets on occasions that were not even useful 'desense sessions', just to have a pee, just like everyone else.
At last I had only one more step to go. I could use a bowl urinal next to someone, reliably. Now to move on to the top of my hierarchy – the dreaded trough urinal, the long, shiny stainless steel effort at the public bogs next to the market. I cycled down there and watched the entrance as I locked up my bike. Someone went in there. I followed them. We stood at opposite ends, of course, toilet etiquette being what it is. I went before he did. It seemed almost too easy. What was the problem? I had to struggle even to recall how I would have felt two months previously. Probably I would have just stood there, my bladder locked up, sweating and feeling humiliated in front of the oblivious guy five feet away. Now all that was gone – a fading memory rather than an unpleasant daily reality.
Don't get me wrong – I'm not claiming to be completely cured. I had a bit of a wobble when I went to the pub urinals with a friend this last week, and had to push for an extra few seconds before the flow got started. But luckily we were gossiping about something or other: blokes' bog chat, when you can be rude about women with no-one else minding, and this took my focus off peeing bit. We left the room together, the sheer normality of the situation giving me a rush of pleasure. I'll keep on practising I know, because I'd hate to have a relapse, and it's got to take more than two months to unlearn over twenty years of avoidant behaviour. But the fact remains – I'm largely cured already, and I can expect further progress if I keep at it. I even feel a little pride – apart from Chris McCullough's help I've done this all by myself (I never told anyone, because this would have reinforced the humiliation and anxiety for me) with no magic bullet or drugs or anything. Just little by little, the way one learns (or unlearns) anything.
Now to book that open boat trip up the Amazon…