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Stephen Soifer

Sam Holden

By Edward Ericson Jr. | Posted 1/19/2005

Offices for the Shy Bladder Institute, the International Paruresis Association (IPA), and the North American Restroom Association (NARA) all reside in a modest three-room suite on the second floor of 1609 Sulgrave Ave. in Mount Washington Village. Steven Soifer founded or co-founded all three related nonprofits and presides over their global efforts to evangelize for cleaner public rest rooms that offer more privacy—the International Paruresis Association even sent a delegate to the World Toilet Organization’s summit meeting in Beijing last October. Soifer has co-authored a book (2001’s Shy Bladder Syndrome: Your Step-by-Step Guide to Overcoming Paruresis) and appeared on television and radio, including Howard Stern’s syndicated morning show. As you might imagine, Soifer is one of the foremost experts on shy bladder syndrome—the inability to urinate where others might see or hear you. According to a Harvard University study, nearly 7 percent of adult Americans suffer from some degree of paruresis, which is a Greek word meaning “inability to void.”

City Paper: So, who are you?

Steven Soifer: I am an associate professor of social work at the University of Maryland. Seven years ago I co-founded the International Paruresis Association with Carl Robbins—he works at the Anxiety and Stress Disorder Institute at Sheppard Pratt Hospital. The Shy Bladder Institute is sort of our therapy arm.

I’m going to Australia for a workshop in Melbourne from the 14th to the 16th [of January]. Public rest rooms in Australia are nasty—they’re just walls to piss on. I have no data on this, but my guess is that the incidence of paruresis [in Australia] is higher because of that. The macho image of Australian men is mostly myth. And that brings us to my issue: How does rest-room design effect people’s peeing behavior?

CP: Do you have paruresis?

SS: I do, indeed. Since I was 13.

CP: What causes it?

SS: Primarily, some trauma—not necessarily that big or serious, sometimes it’s as small as a comment from a parent. Sometimes it’s congenital—a smaller bladder neck—but half of our patients remember an incident which triggers it.

CP: What about your own case?

SS: Kids tried to break down the door of a rest-room stall I was in.

CP: So what is the North American Restroom Association?

SS: Essentially the organization was created to promote greater availability and accessibility to public rest rooms and better design for people with shy bladders—for instance, floor-to-ceiling partitions, which are standard throughout Europe. About four months ago Carl [Robbins] and I incorporated NARA. I finally asked the board [of the International Paruresis Association] to allow us to incorporate a separate entity because the agenda is different enough to require a separate institute. IPA is now a subsidiary of NARA.

CP: How is the agenda of NARA different from IPA?

SS: Because of the issue of incontinence. Incontinence relates to bathroom design and availability.

CP: So that’s a NARA issue?

SS: Yes. I didn’t realize that building codes require that each store have a toilet for customers—and that just being inside the store is enough to make you a customer. In China, in Beijing, they’re doing a project to ensure you’re never more than an eight-minute walk from a public rest room. Try finding a public rest room in New York City!

I did a workshop in Manhattan and discovered a self-cleaning public toilet. There are several companies marketing them—the one I remember is called the Exeloo. Some cities are installing these—Seattle is one. They’re free, paid for by advertisements on them. But in New York, the city council resisted at first. You know why? They were afraid that the homeless people would start living in them.

So the [self-cleaning] toilets—every 15 minutes the door automatically opens. Imagine that. Imagine you’re sitting in there with diarrhea or something when that door pops open.

CP: How many members does NARA have?

SS: Right now we don’t have a formal structure. There’s a list of the officers on the web site. Myself, Bob Brubaker from Metroped—that’s an advocacy group in Washington, D.C., for people with incontinence. Tom Achatz, president of IPA, David King, who went to the [World Toilet Organization] meeting for us—he’s secretary of the board for IPA. Tom Keating, who runs Project Clean out of Atlanta, he works on making school bathrooms tolerable for students, from elementary school through high school. Kathryn Anthony, a professor of architecture.

CP: An architect?

SS: Yes. [Alexander] Kira’s book [The Bathroom], which I quote from extensively, is the classic in this field. He talks about privacy from and privacy for—most people don’t make that distinction. There was no concept of urinary privacy until the turn of the [20th] century. The old Roman toilets were not gender-divided, for instance. People sat together on them and talked politics. Even on the U.S. plains, the outhouse was a multiseat, and the whole family would go at once. In part that was for safety reasons. In Bangladesh today, urination and defecation are still a public function. . . .

CP: How have you gotten your message out?

SS: We’ve had better luck with radio and print than with television. I was interviewed twice over the phone by Howard Stern. It went well, actually.

CP: Is he paruretic?

SS: He is. So is Oprah [Winfrey]—she admits it—but we can’t get on her show.

CP: What were you doing before you took up this cause?

SS: I just, you know, professed.

CP: So, who is affected by paruresis, and how does it affect those who have it?

SS: About 7 percent of the population. Men and women are equally affected. My son is 5—he has it. It affects all ages, but it usually develops around puberty. The oldest client I have seen was 87 years old when he contacted us. The average age of onset is 11 or 12.

Paruresis is a social anxiety disorder and it ranges in severity. It could be anything from an occasional misfire at a bowl game to full agoraphobia. One woman we treated could only go in her own backyard at night. She came in for one session, and then we never saw her again.

CP: How do you treat it?

SS: First we make sure it’s not a physical problem. . . . Then we have a treatment protocol, which we call graduated exposure. It’s eight to 12 sessions bringing the feared item progressively—or in this case, bringing the client to the feared item. So you go to a hotel room and have the person go into the bathroom and urinate, with the door closed, while the [therapist] waits outside. Later you work up to them going with the door open a crack. As a male, eventually you go inside the room, [with someone] standing behind you to simulate the experience of a public rest room. Eventually we take people—the best place we’ve found are casino bathrooms. They’re usually huge, and well-attended, and not too crowded because people don’t want to leave their seats [at the gaming tables].

CP: Which is another difficulty altogether. Where have you traveled and lectured on this issue?

SS: I’ve been to the U.K. a couple of times—now the [paruresis] group [in England] is off on its own. The German-European paruresis association is kind of fumbling along. We’re going to get it restarted. There is one in Canada, but they don’t want to be independent of us yet. And we have support groups in about half of the U.S. states. California is very active.

CP: And how are you funded?

SS: Almost exclusively though membership. The IPA’s budget is $75,000, and most of that comes from workshop fees. We’ve had almost zero success raising money through foundations. I have put in for [Food and Drug Administration] funding on the cause of paruresis, but usually we’re just too far out there for grants. We’re not exactly on Mars, but maybe on the moon.

CP: I would think the condition would be well known by now.

SS: We do get blank stares, still, but everyone has a story. Almost everyone knows people who have or have had it. I like to say you can make anyone paruretic, or induce the symptoms, by creating the right conditions—crowding them, or during drug testing, or in prison. They say, “Drop your pants and we’re going to stare at you while you try to pee.” I think 80 or 90 percent of the population would have problems.

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