Bathroom Stage Fright A “Real Condition” : Scientists Again Prove What Was Already Known

In standard science-report prose, MSNBC begins:

Given the choice, you probably prefer your home porcelain throne to using a public toilet. But for more than 20 million people in North America, peeing in a public restroom is no simple matter.

People with a “shy bladder,” a real condition also known as paruresis, are fearful of urinating when other people are nearby.

So is the considered opinion of “Carl Robbins, director of training for the Anxiety and Stress Disorders Institute of Maryland in Baltimore, who has worked with paruresis patients for more than 20 years.”

What concerns us is the phrase “real condition,” whose opposite, we may infer, is “imaginary condition,” in the sense of a condition thought to be real but actually not; it is instead a figment of over-active imaginations, or a construction based on misinterpretations.

In this case, everybody—that is, everybody who cared to think about the subject—already knew about shy bladder based on observations taken with their own eyes, or from reports from others, or from their own experiences. That is, we already knew that some people at some times suffer (if that is the word) from shy bladder. The behavior called shy bladder was seen to be true and was well known.

So why did MSNBC, and the many other affiliates who reported on Carl Robbins’s press release, say with a mood of “at last we know” that shy bladder was a “real” condition? Presumably the reporters already knew it was real. So why say it?

There are two reasons. The first is a kind of worshipful scientism which works like this on a person’s thinking. “I have believed a thing, but now a scientist has told me what I believed is true, therefore it is true.” Before hearing the report, this person had full confidence in his belief based on the evidence of his experiences. But after hearing the report, a small doubt enters in the form of, “What I believed could have been wrong. ”

This small doubt is instantly relieved because a higher authority has confirmed the belief. But a residue of doubt lingers. Not about the belief, which is indeed strengthened (perhaps even inappropriately), but in the confidence a persons has about other beliefs that have not yet been “confirmed.” This is often of no great consequence, and can even be helpful in areas where people opine on subjects with which they have no experience (fundamental physics, chemistry, etc.). These are rare situations, though.

The habit of looking to science to confirm (or disconfirm) everyday beliefs can be harmful, especially when those beliefs are about the behavior of other people. Science here—that is, scientists here, like sociologists, psychologists, economists, and so on—have shown they are as prone, or more prone, to error than non-scientists. Just look at how often these fields have changed their “fundamentals” over the past century.

The second reason the report used the words “real condition” is another form of scientism, this one where a scientist cannot bring himself to say whether a thing is true unless that thing can be explained by a theory.

Recall that we already knew, based on years and years of experience, that some people had shy bladder at some times. It is natural and of interest to ask why. But regardless whether we can figure the answer, it does not change the evidence we have that the thing itself is true.

It is a mistake, therefore, to say that the thing might not be true because we cannot say why it is so, or because we cannot say how it fits into some theory. You might not understand how a jet engine works, but your observation that the plane flew you from A to B still corroborates your belief that planes can fly (and it doesn’t matter that some other guy does know how the engine works).

Now, it sometimes happens that a scientist is right to reject observational evidence because that evidence does not fall within that expected by some theory. But this is rare, because this means the evidence really is in error. I have in mind such things as faulty sensors in a chemical process, or information on food recall questionnaires.

It is more likely that a scientist discounts genuine evidence because it does not fit into a cherished theory. Or he is more likely to accept dicey evidence because that evidence corroborates a desirable theory. Once again, these mistakes occur more often in the less quantitative sciences.

Carl Robbins issued his press release because he was able to classify shy bladder with a scientific sounding Greek term, itself implying consonance with some theory of human behavior to which Robbins subscribes. Whether that theory is true is not of interest to the question of whether shy bladder exists, because we already knew it did.


  1. We call these TSIB (tee-sib) analyses. Not sure if we invented the term or not, but it had to do with an undergrad physics class where we showed “the sky is blue”. As if none of us knew it up until then.

  2. The correct term for those bladders is introverted, not shy. They obviously need some psycological counselling.

  3. Maybe by ‘real condition’ they mean that it is a distinct condition in and of itself, as opposed to a symptom or manifestation of another medical condition.

    In other words, you can have ‘shy bladder’ without having any other medical issues.

    A cough would not be a considered ‘real condition’ in that it is a symptom shared by a variety of different medical conditions.

  4. Will,

    Even if that were true, which in this case it does not seem to be, it would not change the fact the shy bladder is still true and was not in need of confirmation.

  5. Someone ought to perform a study showing that many studies prove things that people already know.

  6. I think I see a correlation between this and the blog on the 2nd and 4th finger length.

  7. How would you describe it if someone thought they had a shy bladder in public restrooms, but it turned out they were simply impatient in ‘public’, and were similarly slow to urinate in their own home, just not bothered by it?

  8. Would you have committed excessive scientism if you bothered to ask whether or not I had, in fact, issued a press release? I was interviewed for the article which was initiated and written by the author.

    By the way, there are very powerful people who determine the barbaric drug-testing laws in this country who DON’T BELIEVE shy bladder exists. The amount of suffering that results from their denial is unnecessarily cruel.

  9. Carl Robbins,

    I’m sending you a follow-up email to offer you a chance for a full rebuttal. But note that I never claimed that shy bladder does not exist. I merely claim that most, or even all, people think it does. That some don’t think it serious enough to warrant drugs is a different story which I said nothing about.

    Central is my claim that the story found interest because of the causes I asserted (scientism, chiefly). Your story is far from unique in this way.

    I was misinformed about the “press release”, for which I apologize. I guess because the story was picked up at so many places simultaneously, there was confusion.


    I’ve never met somebody so impatient that they cannot pee. Perhaps you are onto something and should consider publishing your findings.

  10. And, now another (which, again states the bleeding obvious) study that says people are happier on weekends than they are during workdays. Maybe it is because they are home and can relieve themselves in private…

    Weekends and Subjective Well-Being
    John F. Helliwell and Shun Wang
    NBER Working Paper No. 17180
    June 2011

    This paper exploits the richness and large sample size of the Gallup/Healthways US daily poll to illustrate significant differences in the dynamics of two key measures of subjective well-being: emotions and life evaluations. We find that there is no day-of-week effect for life evaluations, represented here by the Cantril Ladder, but significantly more happiness, enjoyment, and laughter, and significantly less worry, sadness, and anger on weekends (including public holidays) than on weekdays.

    Love this quote:
    “The coefficient for public holidays for the Cantril Ladder is positive and significant at the 5% level, however, we might not be able to draw the conclusion that there is a holiday effect since the coefficient is not stable across model specifications.”
    We might not be able to draw a conclusion…??? Wow, real science at work!

  11. I had never heard of the malady until I read this article. About the only time I have noticed such things is in public restrooms were some old guy just stands there a long time apparently waiting for something to happen.

    I assumed old guys had problems. As I enter my older years I will endeavor to drink lots of water and beer to keep the bladder lively.

  12. I will only believe in Bathroom Stage Fright if someone provides a p value. What is the p-value?!? Can someone give me a p-value?!?

  13. While I didn’t say anything about being to impatient to pee, I guess the relevance (and even sense) of my question depends on what is actually meant by “shy bladder”.

    That’s also got something to do with the more notable aspect of this report. Sure, a scientistic approach to what is real is common (and unhelpful), but now that I’ve actually read the article, I reckon most of the work of the term “real condition” is attempted by “condition”, not “real”. They’re not trying to draw a line between what is and what isn’t, but between recognised medical issues which deserve attention and unremarkable facts of life. Despite the fact that “condition” applies very well to the latter, it is used with the connotations of a “medical condition”, reinforced by the description “real disorder” towards the end.

    The troubles in drawing such a line are a different, if related, problem to that of scientism, imho.

    (You also seem to have completely missed Carl’s point wrt drug testing.)

  14. Allow me to clarify the drug-testing issue: Imagine whether or not you could get a job, keep a job, or stay out of prison depended solely on your ability to pee in a cup while being observed? Well, that is the terror that many people in this country face. People with paruresis (shy bladder) have been denied employment, fired, and sent back to jail for being unable to produce a urine specimen in a timely manner. The involuntary lock up of pelvic floor muscles is often consider a FAILURE in a drug-screening test. They are denied the option to provide alternative specimens – blood, saliva, or hair.

    And, what do some MRO’s (medical review officers) and bureaucrats who set drug-testing policy say about this travesty? “SHY BLADDER DOESN’T EXIST.”

    Unfortunately, we (the International Paruresis Association), a non-profit advocacy and educational organization, is compelled by the powers that be to PROVE that shy bladder is a real and sometimes disabling condition.

    Yes, it is easy to ridicule and dismiss people who suffer from this problem. I invite you drop your skepticism and sarcasm long enough to see the very REAL suffering that exists.

    The semantics don’t matter.

  15. Paruresis (shy bladder) is difficulty urinating in the presence of other people. We actually have some evidence from a few MRI and neuro-urological studies that there is an abnormality in the pelvic floor (i.e. chronic spasm). That being said, what distinguishes paruresis from other problems with urinary retention is that most sufferers have no trouble urinating when alone.

    Paruresis is clearly a mind/body problem.

  16. ¨worshipful scientism¨ / narcissistic confirmation bias: !!!!!

    Carl Robbins:
    When your studies identify the cause, please work on inducing the effect: I can stop buying diapers – for both my grandchildren and me.

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