SOME NOTES ON PSYCHOLOGICAL SIGNIFICANCE OF URINATION

Observations on the psychological significance of urination in adults were gathered by psychotherapy with 11 patients on chronic hemodialysis. Patients examined before the beginning of dialysis refused to believe that they would stop urinating. This suppression was understood as part of the denial in regard to the terminal kidney disease. It was clear, however, that the threat of loss of urination per se was very stressful. The denial of the nearly complete loss of urination led to manifestations such as exaggeration of the remaining function. This denial was further increased in the patients who underwent bilateral nephrectomy and it resulted in phantom phenomena, which included urgency and the desire to urinate, as well as “phantom urination. Further evidence on the psychological importance of urination was gathered from patients’ behavior concerning this subject: when competitive relations developed between patients, it always included competition in urinary output; when a patient wanted to offend another patient he told others about his enemy’s lack of urination; patients refused bilateral nephrectomy, saying that without urination people are “half human.” The patients, especially the men, were eager for transplantation, even those who had adapted well to chronic dialysis. This, too, it was suggested, was due to, in some extent at least, their wish to regain urination. These observations made us realize that urination is of great emotional importance to adults facing the loss of urination or having actually lost this function. We did not have information on the emotional importance of urination to “normal” adults. Our impression was that urination is of some emotional importance to all adults and that threat of loss or actual loss of this function causes regression to pregenital stages of development and renewed hypercathexis of urination. It was further suggested that potency troubles observed in chronic hemodialysis were not due to underdialysis, but to this regression. © Williams & Wilkins 1969. All Rights Reserved.