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SHIT DOESN’T HAPPEN Lifting the lid on Shy Bowel running in the first place, and creating viable solutions for my many r
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SHIT DOESN’T HAPPEN Lifting the lid on Shy Bowel BAZ CHALABI
SHIT DOESN’T HAPPEN Lifting the lid on Shy Bowel
SHIT DOESN’T HAPPEN Lifting the lid on Shy Bowel First published 2008 Copyright © Baz Chalabi 2008
Baz Chalabi has asserted his right under the Copyright, Designs and Patent Act 1988 to be identified as the author of this work. A CIP catalogue record for this book is available from the British Library. Published by Baz Chalabi. Edited by Catharine Stott ([email protected]) Illustrations by Frank Adam ([email protected]) Printed and bound by Jam Jar Ltd, Bristol, United Kingdom.
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For all those who have had to carry the invisible burden of this condition silently and alone – who have not been able to live their dreams because of society’s immature and ignorant taboos around mental health, the human bowel, and that most basic of functions…shitting.
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Acknowledgements A big thank you to all my friends who have encouraged and supported me in various ways to write this book. My special thanks go to: My editor and dear friend Catharine Stott, who has given me invaluable support, encouragement and feedback throughout the writing and editing process. My book cover has made your toilet famous. My parents Zu and Gill, who have supported me wholeheartedly, not only throughout my own Shy Bladder and Shy Bowel recovery, but also in the writing of this book. Without your love and support, this book would not have been written. The various therapists, authors and doctors who have assisted me along the path of my recovery from Shy Bowel and Shy Bladder, and helped me stay focused on continuing with it. John Rogers, the webmaster of the Parcopresis website, who has been an absolute star in getting the website up and
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running in the first place, and creating viable solutions for my many requests over the years. Andrew Smith, chairman of the UK Paruresis Trust, for helping me with my Shy Bladder and Shy Bowel recovery, and generous time and effort spent reading and advising on the first draft of this book. Steve Soifer, for suggesting and encouraging me to write a book on Shy Bowel in the first place, giving me great ideas on how to go about it, and for suggesting ‘Shy Bowel’ as a name to describe the condition. Professor Alex Gardner, for suggesting the more medical term of ‘Parcopresis’ for the condition. Jason Dean, for his artistic eye, frank feedback, and technical assistance in creating the book cover. Frank Adam (Fladam) for his most excellent illustrations. Jo Rollason, for her belief in me and the book, and for encouraging me to get on and finish it. The various people who have emailed me over the last several years and encouraged me to write a book on Shy Bowel.
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Sarah and Debbie who came to the Parcopresis workshop and participated fully and frankly. Sarah Williams and Hazel Hammond for their keen-eyed proof reading. And last, but most definitely not least, I extend my deep gratitude and thanks to all the Shy Bowel sufferers who have posted their testimonies and thoughts on the Parcopresis message board of the website. You have helped me in my own recovery and in making this book happen. I sincerely hope it will serve you in your own recovery. I have written it for you.
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“Well has it been said that there is no grief like the grief that does not speak.”
Henry Wadsworth Longfellow
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“Keep your mind, your heart, and your bowels open… and you’ll be alright!”
Anonymous
“There is nothing more overrated than bad sex…and nothing more underrated than a good crap!” Anonymous
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Warning and Disclaimer This book is NOT a substitute for medical advice and does not constitute the practice of medicine, psychiatry, clinical psychology, or any other mental health profession. If you are having trouble defecating, you should always contact your doctor because difficulty with voiding can be a symptom of a serious physical medical condition. You should have your doctor evaluate your condition before diagnosing yourself, and seek the appropriate help if necessary. The author and publisher - Baz Chalabi - is NOT qualified as a psychologist, psychiatrist, doctor or any other form of health professional or therapist. Before following any of the recommendations contained within this book you should consult with your doctor or other relevant health professional. The author of this book disclaims all legal liability whatsoever.
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Author’s note All of the testimonies used in this book first appeared as posts by Shy Bowel sufferers on the Parcopresis help site message board. Thank you to these people who expressed their experiences and reflections on Shy Bowel so candidly and eloquently. This book has been written using British English spelling and vocabulary for the most part. Where there are important terms that need translating into American English I have endeavoured to provide these in brackets next to the British English word. I have also decided to alter the spelling of the British English word ‘poo’ to ‘pooh’. ‘Poo’ just doesn’t cut it for me: too much like ‘po’, too self-effacing; I don’t know, it just doesn’t look right! So pooh it is. As such, no letters or emails pooh-poohing my misspelling please! Finally I may have used American spelling for some words that are, to my mind, difficult in British English: e.g. I prefer ‘fecal’ to ‘faecal’.
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Contents 1 2 3 4 5 6 7 8 9 10 11 12 13 14
A doubly taboo problem How Shy Bowel occurs How do I know I’ve got Shy Bowel? IBS and Shy Bowel Introduction to Cognitive Behavioural Therapy CBT and ‘my shameful secret’ CBT and Shy Bowel Desensitisation Anti-depressants Other therapies Regarding pooh and farts Diet and supplements Stress management and the relaxation response The bottom line
14 31 58 63 70 74 94 116 152 167 174 192 203 231
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1. A doubly taboo problem Imagine that your friends have asked you to go on holiday with them, doing something you’ve always wanted to do: perhaps skiing in the Alps, or relaxing on a tropical island or sailing across an ocean. You would love to go and feel all excited…for about 20 seconds, and then the fear sets in. Unbeknownst to your smiling buddies, you have an internal battle with the fear, and the fear wins. You make your excuses and say you can’t or don’t want to go. Your friends look surprised, and two weeks later off they go on your dream holiday without you. What was that fear that so paralysed you and stopped you from going on the holiday of a lifetime? Simply this: that you wouldn’t be able to pooh in the toilet in the shared holiday 14
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accommodation. Sound ridiculous and absurd? It is. And yet, for sufferers of Parcopresis (aka Shy Bowel), this is exactly the kind of scenario that plays out in their lives. Nor is it confined to going on holiday; it can affect all areas of their lives. From job choice to close relationships, from self-esteem to productivity and fulfilment, virtually all their major life choices start to be made around their Shy Bowel – their inability to pooh near others. And precisely because it is such an absurd and embarrassing condition, sufferers often can’t admit the extent of it to themselves, let alone talk to other people about it. Most sufferers believe they are the only person who has this condition, and that they are some kind of freak because of it. Posted by Tooshy About a year ago one of my best friends asked me to join him and his family on a trip through the USA, of course that's a brilliant idea but the trip was with a camper. I thought about pooping immediately. It just wouldn’t work. I told my friend the exact problem, he said he understood but I feel he thought it was a cheap excuse. No big deal however. We are still good friends but I felt ashamed nonetheless.
What is Shy Bowel?
Shy Bowel might be classified as a specific social anxiety disorder or phobia (although since Shy Bowel has only begun to be talked 15
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about in the last few years, this may not be the most accurate definition). People with the condition, who can often otherwise operate well in social situations, find it impossible to pooh when other people are nearby, or perceived to be nearby. Depending on the severity of the condition, ‘people nearby’ can mean anywhere from the same office floor, to the same house, and even in the house next door. Some sufferers can literally only pooh in their own house, when no one else is around (or only a very limited number of ‘safe’ people, like family members or their partner). Think for a moment about the physical implications of this scenario: a sufferer can effectively end up under a kind of house arrest. They can leave the house, but must always return within a couple of days at most or face severe discomfort. Even when they do leave the house for any length of time they feel uncomfortable because they are carrying around waste in their system. The body wants to excrete and is ready to excrete, but their nervous system won’t allow it to excrete. People with Shy Bowel often report feeling out of sorts or crabby because they haven’t gone to the toilet. This affects their whole outlook on life, their relationship to other people, their work and play. The longer term psychological effects are even more devastating: self esteem, confidence and fulfilment are slowly eroded. Posted by Susan I visited this site for the first time yesterday after a long
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search on the Internet to see if I really was the only nutter who desperately needs the toilet but can't go anywhere except their own house. Lo and behold there are loads of people like me!!!! (To be honest I cried with relief). I have had this problem for most of my life (I’m nearly 30) and luckily it hasn't affected my relationship with my husband. He thinks I’m crazy but will get out of the vicinity if I ask. Things were really bad this week when I needed to go so desperately at work one day and just couldn't – I tried all morning, without of course wanting to raise suspicion with my co-workers (went about six times). It's crazy as the toilets at my work are really quite private. I felt so ill that at lunch time I had to get the train home, go to the toilet and get the train back. This is an hour and a half round trip and is not always possible depending on what's in my diary on a given day. I felt really ill the rest of the day anyway. Must be the toxins. I told my husband and family who think I’m mad. I'm so jealous of people who can just go, but then maybe they have other issues that I don't. I'm not sure how it started but probably deep down I think that doing a #2 is dirty even though logically I know it is totally natural. I just really hate anyone other than my husband knowing I’m doing a #2. I don't know if it will help but I've got in touch with a clinical hypnotherapist and am going to try it out. I'll let you know how I get on. Thanks very much to everyone who has posted messages etc.
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as it really does make me feel better to know I am not the only one, even if I am still living with the problem.
Oftentimes, well meaning people will attempt to provide a solution, such as, “Well couldn’t you just go in the morning before you go out and then you’d be alright for the rest of the day?” While this advice may be well intentioned, time pressure is a trigger for many people with Shy Bowel. They know they only have a limited time before they have to go to work, they might even get up early in order to have more time, but their Shy Bowel registers the time pressure and clamps up. More about this later. Another common response from non-sufferers is something like, “That’s ridiculous, when I need to go, I just go. Why don’t you just eat more fibre in your diet and drink plenty of water!” Again, while their advice is usually well intentioned, they are mistaken. Fundamentally, Shy Bowel is not about your fibre or fluid intake. Why haven’t I heard of this condition before?
Shy Bowel is a form of toilet phobia. People are too embarrassed and ashamed to even admit that they have the condition. It invokes two taboos in western culture simultaneously: ‘mental health’ and ‘bowels’. Indeed toilet phobias are known as the ‘secret phobias’ because people are so very reluctant to disclose that they have them. So Shy Bowel is a doubly taboo condition. Firstly it is an anxiety disorder, a mental health problem, and mental health is still a taboo area in most societies and still carries 18
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a stigma in western societies. Secondly it revolves around that most taboo function of the body: poohing, and that most taboo organ of the human body: the bowels. As an indicator of just how taboo it still is to talk about the bowels, pooh, and poohing, I checked out the Collins Gem English Dictionary (a small pocketsized dictionary often used by foreign students learning English). Was ‘pooh’, or ‘poo’, or ‘poop’ or ‘shit’ in there? No, of course not. Actually, that’s not completely true: ‘poop’ was in there, but the definition read something like, ‘the raised part at the back of a sailing boat’. We’re talking basic human waste product relating to a function as universal and as fundamental as eating, yet the most commonly used terms for it don’t even get a mention in a pocket English dictionary! No shit, I kid you not! I can just imagine it now: “Pooh dear? No thank you dear, we British don’t do that anymore. In fact I’ve had my anus sewn up. I hadn’t been using it for quite a while and it was just taking up space don’t you know.” We live in a world of mass media and communications but you never see James Bond finishing up on the toilet before he drops into see ‘M’. (“You might want to leave it a few minitsh before you go in there Mish Moneypenny.”) The whole reality of poohing, farting and peeing has been for the most part airbrushed out of films, books, radio, nearly everything. What’s more, when we veg out in front of the TV or big screen, our brains switch into an alpha wave pattern very similar to that of someone undergoing hypnotherapy. As a result, our brains are in a more suggestible state and our subconscious minds get the message over and over that poohing, peeing, farting and toilets have no place in the world of human affairs. (The only exception 19
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to this rule is when there is humour involved, or something nasty happens to one of the characters in a toilet situation.) That’s not to suggest that there should be whole films dedicated to basic bodily functions but it does still stand that poohing, farting, and toilets generally, are conspicuous by their absence in the media. As a counterbalance (and because I like toilet humour), you will find various comic takes throughout this book on famous films, books and songs that were never made about poohing and farting. Because of these two taboos, Shy Bowel remains a shameful secret in the lives of many sufferers. Because no one talks about the condition, each sufferer naturally starts to think that they’re the only person in the whole world with this problem. They start to think of themselves as a freak. Self esteem plummets as a result of this skeleton in the water closet and sufferers spend more and more of their lives avoiding environments that could put them in discomfort. This can include holidays, living with other people, moving in with a partner, jobs, and pastimes – things that in theory should give them fulfilment, meaning and joy. Posted by TC Like many who have posted on this site, I too am relieved (not in the way I'd like to be) to know I am not alone with this problem. It runs my life: all plans, including those of my family are affected by this. I have this desire to go poop every day, and not just any old poop, it has to be a good one
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– or else I feel all messed up and out of sorts, and worry that it will result in constipation, and a big bloaty belly that has a neon sign on it – this stomach is full of poop! Holidays are a nightmare, (we always go with friends for a week at a time). I look forward to them with anticipation and trepidation – and always take a car load of laxatives. I realized this was not only a physical problem when I was chock full of laxatives, feeling the gurgles and uncomfortableness in my gut, and still wouldn't let myself go!! The only laxative that truly works then is an enema, and that's not the most discreet cure, which of course becomes a part of the vicious circle. I finally had to tell my travel friend what was up, and I am wondering if it will make any difference this summer when we go away again, since she knows. My kids want to go on a 'big trip' and I should be so excited but the thought fills me with fear. I guess I could just suck it up and not poop for a week, but that would feel so awful. I just went to a gastroenterologist, and she prescribed Zelnorn, I was so mad! I don't think a lifetime of pills is the answer but I get so desperate some times I could try anything. This tires me out so much mentally. Everybody else I know just goes and takes a crap when they want to. Why is Shy Bowel a problem?
Shy Bowel only becomes a problem when it starts to impinge on the way we live. Most people can actually relate to not being able to pooh in certain situations, such as the first couple of nights 21
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when they go abroad on holiday. However, as the phobia becomes more severe, it increasingly affects the lifestyle and well being of the sufferer. It can even lead to feeling suicidal. Whole avenues of life are closed off – job, girl/boyfriend relationships, socialising - to the point that it can feel there is nothing left worth living for. What’s more, because Shy Bowel is an invisible condition that people are too ashamed to speak about, they must carry an invisible burden of emotional and physical pain around with them all the time. Maslow’s Pyramid of Needs
SELFACTUALIZATION EGO (ESTEEM) SOCIAL (BELONGING) SAFTEY/SECURITY PHYSIOLOGICAL
To understand better why Shy Bowel can be such a problem, it is also helpful to look at Maslow’s pyramid of needs. The pyramid is split into five levels with different human needs on each level.
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The general idea is that needs nearer the bottom of the pyramid take precedence over those nearer the top. In the lowest, foundational level are physiological needs such as food, shelter, warmth, and elimination. So if you have trouble poohing i.e. elimination, then more of your energies and attention will be focused on getting this need met and it will take precedence over higher levels like self-esteem and social needs. This explains very neatly why Shy Bowel sufferers will turn down holidays and even relationships because of their condition: their need to pooh regularly and comfortably is more important than these other needs. It also shows how people with Shy Bowel are not fulfilling their potential and living their lives to the full.
Posted by Cain I’ve quit jobs, avoided certain interactions with people, lost some friends, contemplated suicide (many times), and been unable to enter relationships because of this problem. I’ve seen the shrinks, who labelled it severe social anxiety disorder, and taken several medications. I started with 20mg of Activan, and then moved to 60mg of Seroxat. Nothing worked. I went to see a gastro doctor, who put me on 50mg of Cortisone for two months. He said that there was an abnormality in my stomach that would be cured by the medication, but it wasn’t.
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Denial
Denial can set in when Shy Bowel sufferers think they are the only person in the world who has this problem. It is amazing how we can get so used to our pain and rationalize it away. Until we discover that other people have the same condition, we tend to minimize the impact Shy Bowel is having on our lives and our lifestyle choices.
Posted by Kate I have only just discovered this site and just can't believe that I am not alone in this problem!! I have always had a problem doing my business anywhere but in my own home, and even that can be difficult if we have guests in the house. Most of the time it actually hasn’t been that big a problem, as I simply don't go unless I am at home. I do remember one terrible guide trip to Switzerland however where I was unable to go for 11 days!! It was agony, the worst thing was that even when I decided I was desperate and plucked up the courage to go in the dorm toilets I just physically couldn’t do it. I did however get used to this and by the time I was 14 I was able to go on any trip for up to a week and simply not go until I got home.
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Has Shy Bowel always existed as a problem?
Because there has been no research on the subject (and because no one was willing to talk about the problem openly until the advent of the Internet and the potential for anonymous chatting), it is impossible to say how far back Shy Bowel goes as an anxiety disorder. Some people posting on the Parcopresis help site message board report having had the problem for up to 50 years. And the condition could be much older than this. Archaeological investigations Arnold and historical records Schwarzenegger suggest that over the NEVER starred in a millennia people have used movie called many different arrangements when it comes to toileting. The Romans apparently socialised quite freely whilst on the toilet. Their toilets were rows or circles of holes going down into the drainage system. People in societies without drainage systems sometimes set up the toilet area, with a cesspit system underneath it, at some distance from the communal living area. Sometimes people appear to have simply poohed in neighbouring woodlands. Other archaeological evidence points to some societies having bathrooms and the toilet in adjoining cubicle rooms, both linked to a drainage system. In the nineteenth century and the first half of the last century, many dwellings had the toilet outside the house, and even to this day you can find
The Defecator
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houses built for factory workers where the outside toilet still exists. The term ‘outhouse’ itself refers to this kind of arrangement and was common in various countries, especially in rural and worker environments. There seemed to be an understanding that the toilet should be away from other people – presumably for hygiene reasons, but also perhaps because people liked to have a bit of privacy and be away from others when they poohed. For people with Shy Bowel it would certainly be a help for the toilet to be outside, further away from other people in the house. Perhaps in those days, Shy Bowel sufferers had less of a problem simply because the toilet system was set up differently. Then again, just knowing that other people know you are going to the toilet can trigger Shy Bowel in some sufferers. Over time, and with the advent of the water closet, the toilet has been moved into the house, and now toilets are much closer to other living areas. How would people from times gone by manage in our modern world, where the toilet is sometimes right off the main living room? Perhaps it has a lot to do with how we are socialised and the level of privacy we learn to expect. And how we are socialised to toileting depends on our society’s attitudes and beliefs about pooh and poohing. Posted by Hate This Problem Parcopresis has limited my options in that it prevented me
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from joining the military, which I had thought seriously of at one point in my life, and still do to an extent. I had debated about applying to the Royal Military College (I’m originally from Canada) when I was in my teens and had even contemplated joining the officer corps after graduation with my BA, but in all seriousness the main drawback was the bathroom situation which would have been unavoidable. Just thinking about the group toilet arrangements in Full Metal Jacket makes me shudder.
In recent decades, people have started living in smaller and smaller households. Many younger people now live alone. Perhaps this move away from more communal living has sensitised us to the proximity of other people when we pooh. Also, modern houses are ever smaller, the walls ever thinner and less soundproofed (especially at the lower end of the housing market).
Paranoid Android’s story I am so happy I found this site. I have discovered only in the last hour that the problems that have plagued me forever are called Paruresis and Parcopresis. I was almost too shy to type my problem into Google for goodness sake! But I’m so glad I did. What a relief to know I’m not alone. Finding so many other people with the problem is so comforting. But I’m also annoyed that I’ve been living with these problems all my life
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thinking I was the only one and feeling like a freak, because it simply isn’t talked about enough. It’s held me back from so many things it infuriates me: holidays, relationships, university. I’m a spontaneous person but because of these social phobias I have to plan constantly. I’ve finally plucked up the courage to apply to university, and to live there too, hoping maybe my phobias will be ‘cured’ by then; realistically, I know they won’t. This is the first time I’m refusing to let my social phobias control my life, and doing something that normally I would have dismissed because of them. I’m hoping to get an en suite room but even then I’m worried people will hear me next door.
At the moment half the world’s population live in cities and this figure is increasing steadily. In the largest cities, personal space is already at a premium. In Tokyo some workers sleep in little cubby holes, in order to cut living costs, which have become so high compared to wages. It is also clear that depression and its concomitant anxiety are on the increase, as Julia Ross notes in her book The Mood Cure: “We’re in a bad-mood epidemic, a hundred times more likely to have significant mood problems than people born a
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hundred years ago. And these problems are on the rise. Adult rates of depression and anxiety have tripled since 1990, and over 80 percent of those who consult medical doctors today complain of excessive stress. Even our children are in trouble, with at least one in ten suffering from significant mood disorders. Our mood problems are increasing so fast that, by 2020, they will outrank AIDS, accidents, and violence as the primary causes of death and disability.” 1
Anxiety itself is often misunderstood. Some people think that it implies a conscious decision to be anxious about things. However the reality is different. Anxiety manifests in chronic bodily states. Muscle tone, where some of the muscle fibres are active in order to maintain our posture, becomes muscle tension, where too many muscle fibres are switched on all the time unnecessarily. The adrenal glands produce adrenaline and cortisol unnecessarily and gradually overwork themselves. The mind thinks incessantly, worrying about things unproductively. In short, we are in a constant, low-grade flight or fight state. The result is a feeling of tension, tiredness, and discomfort. We never fully relax, and if the situation continues unabated, we burn out. Even though there are now many stress management techniques available, which attempt to solve the problem through relaxing activities which act indirectly on the unconscious nervous system, anxiety remains on the increase. 1
Ross Julia, The Mood Cure (London: Thorsons 2003)
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