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Joined to this is the desire for all sorts of infantile experiences, such as the mother's placing him every night upon the chamber because of his bed wetting. In the later repression the pleasure in the enuresis as well as in the being taken up by the mother becomes a dysuria psychica.
Thus a boy, an only child, who had suffered from enuresis till his seventh year, had regained complete control till his eleventh year, when he went to school. In his dormitory at school was a boy who had enuresis, and who was being fined and punished by the schoolmaster. The enuresis at once reappeared and continued unchecked so long as he was at school.
The manipulation was accompanied by a clicking sensation, caused by the replacement of the dislocated vertebra. The patient immediately showed signs of relief and improved rapidly. Perceptible but feeble movements were made by all the limbs except the right arm. The patient remained in a comatose condition for eight or nine days, during which he had enuresis and intestinal torpor.
If the whole environment of the child is bad, so that such a change of suggestion is not possible, and if enuresis is but one of many symptoms of mental or moral instability, it may be necessary to remove the child and place him under the influence of some one else. Sometimes the prescription of a rubber urinal, which the child can slip on at night, is directly curative.
Now these peculiarities of enuresis seem to me only explicable if we assume that the want of control is due to auto-suggestion, dependent at the beginning on the unwise attitude adopted towards the fault by the nurses and parents, and later kept up by the sense of shame and the mental distress involved.
The treatment of enuresis to be successful must be conducted through and by means of the grown-up persons who have the control of the children. To stop the development of enuresis in early infancy we must intervene to prevent the concentration of the child's mind on the difficulty.
Concerning her enuresis, in its relation to urethral eroticism, the patient relates the following: "When I pressed myself against my mother's or brother's thigh, not only 'the good' came, but frequently also urine with it. At about eight years old there was often a very strong compulsion to urinate, especially at night, which would cause me to wet my bed.
Most of the so-called bladder disturbances of this period are of a sexual nature; whenever the enuresis nocturna does not represent an epileptic attack it corresponds to a pollution. The return of the sexual activity is determined by inner and outer causes which can be conjectured from the formation of the symptoms of neurotic diseases and definitely revealed by psychoanalytic investigations.
The same forces are at work in the production of enuresis, or bed wetting, although the matter is here often complicated by the development later on of a sense of shame and unhappiness in the child. There comes a time when the child passionately desires to regain control and is miserable about her failure, until the concentration of her thoughts on the subject becomes a veritable obsession.
I feel that some such brief examination is necessary if we are to understand correctly the ætiology of some of the most troublesome disorders of childhood, such as enuresis, anorexia, dyspepsia, or constipation, disorders in which the nervous element is perhaps to-day not sufficiently emphasised.
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