Chris Hurl. History of the Human Sciences. Volume 24, Issue 2, April 2011.
Introduction
‘Hit a homerun for your child!’ Mark McGwire innocuously exclaims in a recent television advertisement. The celebrity baseball player could be endorsing anything, from a sugary breakfast cereal to the Special Olympics. But the focus of this particular ad is on bedwetting. In 1999, the National Kidney Foundation put together a multimillion- dollar campaign to address this damaging stigma, emphasizing that bedwetting is not the child’s fault and punishment is not an appropriate form of treatment. ‘The first step in treating bedwetting is to have an open dialogue about the condition’, says Gil Rushton, MD, chairman of the National Kidney Foundation’s Enuresis Committee. ‘For children and their parents to see a hero like Mark McGwire advocating such discussion, it can only help families want to learn the facts.’ The campaign includes a series of radio, television and magazine advertisements promoting a toll-free hotline which parents can call to inquire about the condition.
The National Kidney Foundation’s campaign is just the latest in a seemingly endless struggle for the regulation of bodily fluids. As Glicklich (1951: 874) notes, the problem of bedwetting was ‘born with the dawn of civilization’. No method or treatment has ever fully contained this elusive condition. No analysis has sufficiently defined its causes. Bedwetting has posed a slippery problem for the human sciences. Between waking and sleeping, infancy and childhood, it exists in a fluid space, an uncertain moment which cannot be neatly circumscribed. Confounding clear-cut boundaries between the normal and pathological, it often evades regulation, demanding the application of a wide array of different treatments, each based on a distinct conception of the relationship between body and personality, human organs and personal conduct. In tracing the social history of bedwetting and its regulation, I will examine the ontological assumptions underpinning the treatment of bedwetting and how they have changed over the past two centuries.
Analysing medical journals, newspaper articles and magazine advertisements from the United States, Canada and the United Kingdom, I will trace the emergence of bedwetting as a problem space within which different technologies are deployed, combined and recombined. Drawing from recent studies in science and technology, I will identify the different topological frameworks that have been deployed in conceptualizing and regulating bodily fluids. Rather than presuming that the human body already exists fully formed, I will examine how different technologies and regulatory practices have enacted the human body in the treatment of bedwetting. Specifically, I will examine how the human body is enacted through naturalistic, mechanical, circulatory and baroque topologies.
After briefly describing the naturalistic treatment of bedwetting in the early medical almanacs of 16th-century England, I contextualize changing conceptions of bedwetting in relation to the growth of urban centres haunted by a ‘crisis of filth’ in the 19th century (Barnes, 2005). This led to the emergence of institutions for the management of bodily flows, which, through the 20th century, developed an increasingly specialized knowledge of public hygiene. The enclosure of children within the domestic sphere as well as in public institutions such as schools and orphanages, and the partitioning of the human body through the budding human sciences, were mirrored by the development of mechanistic topologies that sought to contain bodily fluids, isolating the human bladder, cutting it off from all external influences.
I go on to examine the treatment of enuresis through the prevailing discourses of the 1940s and 1950s – behavioural psychology and modern psychoanalysis. These regulatory knowledges provided the foundation for the extension of the human body through a wide array of technologies and training techniques. The development of circulatory topologies led to the augmentation of the human bladder, integrating it in a broader circuit, utilizing the bed as a means of conditioning the body. The emergence of the behavioural model of enuresis was mirrored by the development of psychoanalytic views, which would increasingly view bedwetting as a symptom of personality disorder to be treated through cultivating the capacities of children to self-manage and extend control over their environment.
However, it should not be assumed that the development of new technologies has enabled the stabilization of the body as a target for regulation. As Shilling (2003: 3) notes, ‘the more we have been able to control and alter the limits of the body, the greater has been our uncertainty about what constitutes an individual’s body, and what is ‘‘natural’’ about a body’. In this sense, the historical emergence of various technologies for the treatment of bedwetting has been double-edged. On the one hand, the treatment of bedwetting entails the enactment of an object, augmenting the powers of the human bladder in alliance with a wide array of technologies. On the other hand, the treatment of bedwetting has demanded the constitution of a subject, cultivating an interior space to be managed by a wide array of regulatory agents, from parents and social workers to paediatricians and psychologists.
It is the tension between the enacted object and subject constitution that I argue characterizes the ‘modern baroque body’. With the proliferation of different technologies and techniques for the treatment of bedwetting, an overarching view of the human body has been increasingly displaced. As the distinction between the individual and the environment blurs, bedwetting is increasingly managed through multiple bodies constituted by a range of regulatory agents.
Governing Matter: from the Naturalized Corpus to the Circuitous Body
Recent studies in science and technology have problematized traditional conceptions of the human body as a closed and coherent object standing passive and immobile under the singular gaze of medical science (Haraway, 1991; Mol and Law, 1994; Garrety, 1997). In fact, the constitution of the human body as a unified object of examination has posed a persistent problem for the human sciences. Medicine does not begin with the body as a pre-existing and coherent whole, Mol (2002: vii) argues, rather ‘medicine enacts the object of its concern and treatment’. Pragmatically assembled and reassembled, the body is skilfully moulded into a stable object for intervention through different methods of treatment. Its boundaries and capacities are differently delimited through a variety of regulatory knowledges and technologies. In this sense, Mol and Law (1994: 643) contrast an anatomical view of the body, fixed under a given set of coordinates, to a topological view which ‘articulates different rules for localizing in a variety of coordinate systems’.
Through the 16th century western European medical almanacs attest to the predominance of naturalistic topologies in which the body is subsumed under nature as an overarching and pre-existing totality (Shilling, 2003). The retention of urine remains a problem for the bladder rather than the human will (Glicklich, 1951; Gill, 1995). The prescribed treatment advanced in early medical almanacs speaks to the persistent power of analogy in the budding human sciences, as it was believed that similar objects found in nature, such as animal bladders, would enhance the capacities of the human bladder to retain urine.
This would quickly change in the 17th century. With urbanization the control of disease and the corresponding cultivation of proper hygiene became a central concern for the sanitarians and the increasingly specialized medical profession. As Turner (2003) notes, the leaky body came to evoke the danger of disorder and contagion. The treatment of bedwetting was no longer subsumed under an overarching conception of nature; rather, as Foucault (1970) notes, the body came to be measured and calculated, dissected and divided into its distinct functions through a wide array of regulatory knowledges. The self-discipline of the human subject, inculcated within a wide array of institutions – from schools and orphanages, to the factory and the household – was matched by the mechanistic partitioning of the human body into a series of compartments.
However, while Foucault examines the constitution, classification and containment of the modern subject through the development of the human sciences, he neglects to account for how the boundaries of the human body were also blurred through extending bodily capacities in alliance with new technologies. While the body was initially conceived of as an interior space responsible for the containment of bodily flows, the development of new technologies through the 19th century led to the problematization of the body as a closed and coherent entity (Shilling, 2003). While bedwetting was initially treated through the development of contraptions seeking to stop the flow of urine, this gradually gave way to a circuitous view of the human body with the emergence of the behavioural sciences in the late 19th century. In contrast to treatments seeking to contain the flow of urine within the body, the bladder’s capacity to retain urine is augmented through its articulation in a temporary assemblage that attempts to channel the circulation of bodily fluids as a way of conditioning the body. This is reflected in the development of the electrified mattress pad, which continues to be endorsed by many paediatricians today as one of the most effective methods for treating bedwetting. However, the conditioning of the human body through the simple stimuli of behavioural psychology has not gone without contestation.
The biopathologization of the human bladder resides in uneasy tension with a psychopathological view in which bedwetting is symptomatic of a maladjusted personality. From a psychoanalytic perspective, proper toilet-training is viewed as essential to the development of the ‘total personality’. Against the ‘one-dimensional’ technology of the mattress pad, it is argued that the human body must be rendered productive through the ‘infolding’ of a heterogeneous network of authorities each of whom seeks in its own way to influence the manner in which we manage and understand ourselves (Rose, 1996). The problem of bedwetting has been consequently viewed as a problem of extending control over one’s environment.
Through the 20th century, we see the emergence of a wide array of different disciplines and technologies that come to be pragmatically articulated together in novel combinations in confronting the regulation of bodily flows. However, the proliferation of different regulatory agents including not only parents, but also doctors and behavioural psychologists, as well as technologies such as alarms, diapers and drugs in the treatment of bedwetting, does not necessarily imply greater control over the body. The treatment of the enuretic subject is not based on the recognition of a single enuretic body, but is rather regulated through the fluid interplay of diverse disciplines and technologies that do not necessarily cohere or depend upon one another. Hence, I introduce the notion of the baroque enuretic as a means of describing the proliferation of a wide array of technologies in treating the leaky body, which are not oriented towards an overarching view but flow out ‘in many directions, blurring the distinction between individual and environment’ (Kwa, 2002: 26). From this perspective, the body is not a single or stable object. In advancing a baroque conception of the body, I hope to show how the fluid and multiple enactments of the human body continue to pose significant challenges for the human sciences in cultivating the subject’s capacity to self-manage.
Of Hedgehogges
While bedwetting has long been considered a condition demanding treatment, in the context of 16th-century England it was not connected to the shame and secrecy that would later characterize bodily excretions. On the contrary, the human body was symbolically infused with its environment. Life in the rural village was ‘governed by a mesh of correspondences combining animals, plants, and humans into a common destiny’ (Quincy-Lefebvre, 2001: 334). Urine and excrement played a symbolic role in the community which was both regenerative and degrading. They were ‘blessing and humiliating at the same time’ (Bakhtin, 1984: 151). Far from a private shame, urination was out in the open. There was no prescribed location for the excretion of wastes; rather, ‘most excretion took place outdoors, and there was little, if any social opprobrium attached to this form of defecatory display’ (Inglis and Holmes, 2000: 225). Bedwetting was treated through a variety of rites and rituals and the natural order was restored by symbolically subordinating the body to the ‘overwhelming social and cosmic totality’ (Quincy-Lefebvre, 2001: 334).
Beginning in 1545, when the first book on paediatrics was published in English, techniques for the treatment of bedwetting were disseminated through a series of medical almanacs and handbooks. In The Boke of Chyldren, Thomas Phaire (1955[1545]: 38) argues: ‘Many times for debilitie of vertue retentiue of the reines or bladder as well old men as children, are oftentimes annoied, wha their vrine issueth out either in their slepe or waking against their willes, hauig no power to reteine it whan it cometh.’ It is notable here that Phaire emphasizes the powerlessness of the human will. It is not a matter of gauging child development or cultivating a proper training regime. In fact, the treatment of bedwetting is no different for old men than for children. The ability of ‘vertue retentiue’ is disarticulated from the ‘wille’; the body is separated from the soul.
The problem of bedwetting is conceptualized through a naturalistic topology, in which the body is subsumed under the natural world as a pre-existing totality. The whole is considered to be real, pre-existing the activity of the subject. The body, as Shilling (2003: 37) notes, is viewed as ‘the pre-social, biological basis on which the superstructures of the self and society are founded’. Through the 16th century, before the human sciences came to be specialized and sequestered in laboratories, the link between the body and the environment was largely symbolic. As Foucault (1970) notes, ‘the experience of language belongs to the same archaeological network as the knowledge of things and nature’, the relation of languages to the world, he argues, is ‘one of analogy rather than of signification’ (Foucault, 1970: 41, 37). Language does not yet reside over and above the world in ambitions of sovereign articulation signifying relationships between identities; rather, these identities coexist in a complex web of resemblances.
Consequently, early medical practitioners advanced a humoral or organic therapy approach for the treatment of bedwetting (Glicklich, 1951; Gill, 1995). Phaire looks to the use of the urinary powers of animals to enhance the ability of the human to retain urine. In his section on ‘Pyssying in the Bedde’, Phaire (1955[1545]: 38) prescribes ‘the wesande of a cocke’, ‘the stones of an hedgehogge’, and ‘the clawes of a goat made in pouder drunken, or eaten in pottage’. It was thought that by ingesting the organs of different creatures, the power of the child’s bladder to retain urine would be enhanced. As Glicklich (1951) and Gill (1995) note, this humoral and organ therapy approach was widely adopted in the works of other 17th-century practitioners.
The Crisis of Filth
In stark contrast to the ‘stones of an hedgehogge’, through the 19th century paediatricians sought to cut off the circulation of bodily flows, separating the body from nature. During this period, the growing power of the human sciences was marked by a struggle to expunge superstition and magic in order to subsume nature under the scientific order. New approaches to bedwetting came to rely on proof by comparison, drawing divisions between identity and difference, enumerating all elements constituting ‘the envisaged whole’ through a common unit of measurement (Foucault, 1970). They no longer were based on drawing things together but in discriminating, in establishing a differentiated system of classifications.
The attempt to draw clear boundaries between the body and its environment was mirrored by the development of technologies which sought to cut off bodily flows. Praising the treatment of incontinence of urine by ‘mechanical means’, a doctor argues in a prominent medical journal in 1864 for the utility of a vice, which he describes as a ‘formidable rat-trap looking instrument’ for retaining urine in male children. ‘It must be accommodated to the size of the penis, and taken off whenever the patient finds an inclination to make water’ (Wilks, 1864: 681). Through the late 19th century, various manipulations and gadgets were adopted in attempting to stop the flow of urine in the sleeping child, including tightly wrapped bandages and a wide array of adhesives that were applied to the urethra (Glicklich, 1951: 868). These innovations marked a discursive shift to modern paediatrics, constituting an apparatus for the regulation of bodily flows that placed the bladder in relation to new technologies.
Bodily flows were problematized through the 19th century with the increasingly cramped living conditions that came with urbanization and industrialization. In the 19th-century literature on political medicine and public health, urine and excrement became associated with filth, disease and the immorality and degeneracy of the lower classes. For instance, in The Condition of the Working Class in England, Engels (1969: 71) examines the deplorable conditions facing the ‘poorest, most depraved, and worthless members of the community’, the source of the most ‘frightful epidemics’ spreading desolation across the great cities. What was once a sign of regeneration quickly became intolerable as Engels (ibid.: 82) describes neighbourhoods ‘so dirty that the inhabitants can pass into and out of the court only by passing through foul pools of stagnant urine and excrement’.
Through the 19th century, doctors, social workers and other professionals invoked a ‘crisis of filth’, mobilizing their knowledge in demands for the constitution of new sanitary practices (Barnes, 2005; Poovey, 1993). It was thought that proper hygiene could be cultivated through the enclosure of bodily flows. Increasingly, there was a shift from norms of faecal visibility to faecal invisibility, ‘from defecation occurring in primarily ‘‘public’’ locales, to mostly happening in locations deemed to be private’ (Inglis and Holmes, 2000: 226). This led to greater self-regulation as ‘the moment of excretion’ was increasingly delayed ‘until an appropriate time and place presented themselves’ (ibid.: 227).
These practices were enforced through the enclosure of the population within a range of institutions. In the workplace, the household, the boarding school and the orphanage, bedwetting was considered to be an economic and social hazard and in its treatment cleanliness was very directly connected to the self-discipline of the subject (Glicklich, 1951: 863). While bedwetting was previously conceptualized through the subordination of the body to a cosmic totality, it increasingly became contained under an archipelago of disciplinary institutions as a private shame.
In poor families where children were expected to work, bedwetting was considered to be an obstacle to employment. An article taken from an American medical journal dating back to 1870 describes the case of an 18-year-old girl, whose enuresis ‘is not only distressing in itself, but is very injurious to her in her calling as a domestic servant’ (Allbutt, 1870: 733). The inability of many poor families to clean or replace their bedding raised the question of disease, and the child became stigmatized as a source of pollution. Rather than seeking the aid of medical institutions, parents often attributed the condition to a lack of discipline demanding punishment at home.
In disciplinary institutions like orphanages, for instance, children who wet the bed were often not adopted and the treatment of these undesirables consequently became a state problem. This also affected the bourgeoisie as enuretic children were declared ineligible to attend boarding school. The concentration of children in these large institutions led them to become sites for the production of knowledge as doctors, social workers and teachers responsible for their administration began compiling information and experimenting with different methods of treatment. This led to the conceptualization of enuresis as a product of social factors rather than a strictly physical ailment. Numerous studies raised the question that perhaps enuresis was caused by social conditions rather than physiological malfunctions. Consequently, the milieu – the household, the school, the clinic – became the proper site for intervention. Bedwetting was treated less as a problem of the human bladder and more as a problem of self-discipline.
The Circuit of the Bed
With the rise of disciplinary institutions through the 19th century, a mechanical view of the body came to the fore. The body was increasingly integrated under a sterile network of regulatory agents that attempted to expunge all connections with the natural environment. While early technologies aimed to cut off the circulation of bodily flows, the enuretic body was increasingly conceptualized as a circuit integrating organic and inorganic flows quantified and mapped out on a one-dimensional grid.
The view of the human body as a circuit was reinforced with the development of new technologies. As electricity came to be viewed as a ‘vital energy’, agency was extended into the flows of the electrical circuit. As early as 1830, a method of treatment that is described by a doctor in a British medical journal anticipates this form of treatment:
Attach one pole of an electric battery to a moist sponge or a metallic plate fastened between the shoulders of the patient and the other to a dry sponge placed over the meatus urinarius. When this has been done and arranged so as not to annoy the patient, let him be put to bed and the circuit of the bed is completed. (Nye, 1882[1830]: 138)
With the development of electricity, the locus of agency shifted from the hedgehog and the vice to the bed which defines the structure of the circuit. Bodily flows provided a means of activating the circuit as the patient is ‘at once aroused, awakened and caught in the very act and thus caveat is entered by the will of the patient as well as by the electricity against further proceeding at least for this time’ (ibid.: 138). Whereas bedwetting was initially divorced from the human will, treated through humoral therapy that attempted to enhance the bladder’s capacity to retain urine, in the 19th century the will is augmented by the electrical current. With the development of new technologies based on circulation, the dividing line between body and its environment becomes blurred.
Regulatory knowledge and practices had not developed sufficiently in the 19th century to make such an undertaking realistic and the success of such a circuit could only be a matter of speculation. The development of such technology demanded ‘an opportunity of putting it to the test of practical experiment’ and submitting it ‘to the consideration of the profession’ (Nye, 1881[1830]). This would only become possible with the growing specialization of the clinical sciences through the early 20th century.
Until the early 20th century, the bladder remained an elusive object of regulation that could not be fully subsumed under the jurisdiction of medical science. ‘Despite unremitting efforts,’ it was argued, ‘nocturnal enuresis continues to be generally regarded as an unsolved problem’ (Mowrer and Mowrer, 1938a: 436). This led to the proliferation of a wide array of different treatments, including:
Innumerable drugs and hormones; special diets (including fresh fruit, caviar, and colon bacilli); restriction of fluids; voluntary exercises in urinary control; injections of physiological saline, sterile water, paraffin and other inert substances; real and sham operations (passage of a bougie, pubic applications of cantharides plasters, cauterization of the neck of the bladder, spinal punctures, tonsillectomy, circumcision, clitoridotomy, etc.); high frequency mechanical vibrations and electrical stimulation of various parts of the body; massage, bladder and rectal irrigations; Roentgen and other forms of irradiation; chemical neutralization of the urine; sealing or constriction of the urinary orifice; hydrotherapy; local ‘freezing’ of the external genitalia with ice or ‘chloratyl’; elevation of the foot of the patient’s bed; sleeping on the back; not sleeping on the back; and the use of a hard mattress. (ibid.: 436)
Since the object of regulation could not be fully delimited by any single approach, doctors and psychologists, parents and schoolteachers, were compelled to develop their own techniques, melding together local traditions with the increasingly specialized knowledge of the human sciences. Glicklish (1951: 866) describes the sense of confusion felt by the practitioner of the day upon being confronted by the wide variety of explanations offered for enuresis and how ‘in desperation he [sic] would turn to his own faculties of observation and investigation in an attempt to clarify the problem for himself’.
With the growth of medical institutions during the 20th century, the development of new treatments shifted from the local ‘practitioner’ to institutions specifically designed for clinical research, primarily universities, hospitals and laboratories, through which new technologies could be rapidly developed and deployed. This trend was particularly evident in the United States where specialized research was increasingly carried out by psychologists, psychiatrists, urologists and clinical paediatricians. While conditioning treatment had been advanced as early as the mid-19th century, it was only in 1938, when two Yale psychologists published their ‘apparatus for the study and treatment of enuresis’ in the prestigious American Journal of Psychology, that the use of electricity would become a predominant technique in regulating enuresis (see Mowrer and Mowrer, 1938b).
Drawing on the emerging regulatory knowledge of behavioural psychology, it was thought that by developing a sensor that could detect moisture, a stimulus could be sent to the body provoking the enuretic subject to respond. ‘By the well-known conditioned-response principle of Pavlov’, it was argued that ‘an increasingly strong functional connection’ could be developed causing ‘the awakening response and the contraction of the bladder sphincter to ‘‘come forward’’’ (Mowrer and Mowrer, 1938b: 446). Invented by Mowrer and Mowrer in 1938, the ‘mattress pad’ linked the bladder in a broader electrical circuit, signalling an alarm upon detection of moisture. This would become the first mass-produced and mass-marketed bedwetting technology in the United States, and would quickly be disseminated through doctors’ offices, medical almanacs and newspaper advertisements.
The conception of the circuit problematized the organic boundaries of the human body, shifting the locus of agency from the human body to the bed. In contrast to the naturalistic view which sought to integrate the human body under the broader domain of Nature, and the mechanical view which sought to cut off bodily flows, the mattress pad became temporarily integrated with the bladder, providing a stimulus that would condition the human subject to awaken upon urinating. The sleeping subject in effect became a passive switch in the broader circuit of the bed.
However, the circuit for the treatment of enuresis did not stop at the bed. As a wide array of technologies for the treatment of the body became affordable for an upwardly mobile middle class following the Second World War, the stains, stinks and pollution of the enuretic child were expunged from the household. Washers, dryers, vacuums, dry cleaning and assorted industrial-strength cleaners became widely available in the advanced industrialized countries. Disposable diapers were introduced en masse in 1946 and quickly came to replace cloth diapers. No longer did bedwetting pose the problem of disease and contagion so much as it was advanced as a problem of personal development to be treated through the cultivation of a proper training regime.
From Total Personality to Self-Help
So far, I have indicated a shift in the treatment of bedwetting from a wide array of drugs, devices and technologies experimented with directly in the household to the specialized labs of the clinical sciences. But rather than suggesting a simple convergence of the human sciences over the past century, I argue that there has been an uneasy relationship between biopathologization, in which various technologies are advanced in attempting to augment the capacity of the human bladder, and a psychopathological view in which bedwetting is symptomatic of a maladjusted personality. Drawing on Freud’s theories of childhood development, psychiatrists became critical of the ‘monosymptomatic point of view which considers the bladder of the child to the neglect or avoidance of the total personality’ (Michaels, 1939: 631). However, while modern psychoanalysis was often advanced in opposition to behavioural psychology, I argue that these two approaches shared a common aim to move beyond an interiorized view of the body by posing the problem of bedwetting as a matter of mastering the external environment.
The mechanized body came to be viewed as symptomatic of a middle-class compulsion for a one-dimensional conception of cleanliness and order which expunged the child’s personality from the picture. Writing in 1950, Erik Erikson argued in his hugely influential Childhood and Society, that western civilization has chosen to take the matter of toilet-training seriously, ‘the degree of pressure being dependent upon the spread of middle-class mores and of the ideal image of a mechanized body’ (Erikson, 1963[1950]: 81). As the home was sterilized through the development of various technologies, enuresis became viewed less as a disease and more as a personality disorder. What was once a physical incapacity became a problem of self-care, which demanded the enlistment of parents in training the enuretic subject. The proper maintenance of the household became less a problem of proper hygiene and more a question of self-actualization.
Erikson came to prominence with the growing popularity of psychoanalysis through the 1950s. Including toilet-training as one of eight stages in development, he explores the maturation of the human muscle system as an early expression of autonomy, giving the child ‘a much greater power over the environment in the ability to reach out and hold on, to throw and to push away, to appropriate things and to keep them at a distance’ (1963[1950]: 82). In short, it was a topological problem which entailed actively redefining the inside and outside, cultivating self-management in order to extend the child’s ability to control the external environment. Enuresis reflected maladjustment not only of the human body but also of the personality. Bedwetters were considered more susceptible to aggression and psychosis; they were less likely to succeed in life and more likely to commit suicide. Enuresis was drawn into the moral panics of the time as it became associated with delinquency, truancy and contrariness. In his article, ‘Enuresis in Murderous Aggressive Children and Adolescents’, Michaels (1961) insisted that bedwetting was indicative of deeper psychological problems that posed a menace to the social order. It was incorporated onto the checklists of child psychologists, police officers and military recruiters. For instance, a 1938 study included enuresis as one of eight factors contributing to the failure of new recruits in the US Navy (Mackenzie, 1945). The problem of bedwetting was increasingly advanced as a means of identifying and classifying psychopathological subjects.
Enuresis became an expression of improper training, suggesting incompetence or abuse on the part of the parents. Punishment was increasingly problematized as a form of treatment, on the basis that it would do more harm than good. One advertisement from the New York Times c.1965 warns, ‘[d]ry bed training may avoid serious emotional problems in your child!’ Recent medical research, it was argued, has proven that bedwetting hinders the development of a healthy personality. While such medical research was taken up by a growing paediatric industry in order to convince reluctant parents to invest in new technologies, the problem of bedwetting continued to escape the domain of medical expertise. It was still regarded as an organic problem treated through a wide array of household remedies or an issue of proper parenting to be dealt with at home. In attempting to carve out an authoritative space for the treatment of bedwetting, the ad draws from the authority of two ‘eminent psychologists’ and claims to be the only physician-patented method of treatment.
With the proliferation of self-help manuals through the 1940s and 1950s, parents were increasingly enlisted under a training apparatus integrating doctors, psychologists and various child development specialists. In 1946, Benjamin Spock, an American paediatrician, wrote one of the most widely published books of all time. Selling more than 50 million copies and translated into 39 languages, The Common Sense Book of Baby and Child Care integrated psychoanalytic theories with modern paediatrics. Reasoning against the application of a ‘one size fits all’ approach to child development, Spock (1946) argued that parents should be more flexible and affectionate with their children, working with rather than against the impulses of the child. By cutting off these impulses, he warned, strict training regimes could lead to personality disorders later in life.
The extension of the human body through the proliferation of postwar technologies was mirrored by the extension of supervision to include a wide array of different ‘childhood development’ professionals, including teachers, paediatricians, psychologists, psychiatrists. The human body was to be rendered productive through the ‘infolding’ of these authorities each of whom sought in its own way to influence the manner in which we manage and understand ourselves (Rose, 1996). However, just as the extension of different technologies for the treatment of bedwetting blurs the line between body and environment, so too does the extension of different regulatory actors. As multiple bodies became apparent as distinct sites of regulation, the human sciences did not converge around a shared diagnosis so much as they proliferated, differently enacting the human body through a range of technologies.
The Baroque Enuretic
When one reads of the number of medicaments, implements and methods, all used in the name of science, he is inclined to believe that when these were all turned on a specific case of enuresis, the disorder just ‘upped and died’ because it was outnumbered. (Glicklich, 1951: 866)
The treatment of bedwetting through the 20th century has been predicated on both extending the capacities of the human body and enclosing the subject under the authority of regulatory agents. Hence, I have shown how behavioural psychologists advanced the human bladder as a biopathological object which demanded conditioning through integration as a part of an electrical circuit. Additionally, I have shown how the development of modern psychoanalysis led to the study of bedwetting as a psychopathological object reflecting the incapacity of the child to extend control over his or her environment. However, as the boundaries between the human body and its environment blur, the notion of a singular body to be acted on has become increasingly problematic. In this section, I advance the notion of the baroque enuretic to describe the proliferation of multiple bodies enacted by a wide array of technologies which do not necessarily cohere or depend upon one another.
Novas and Rose (2000: 489) argue that the emergence of a new ‘active’ subject, which they define as the ‘somatic individual’, reflects the divergence of the body and the soul as ‘the sick person bears their illness within their corporeality and vitality’, rather than within their personality. As such, patients increasingly serve as regulatory actors in the management of their illnesses without personally bearing the stigma of the disease. This can be seen through the emergence of the genetic sciences, for instance, which emphasize the hereditary causes of disease. Through the 1990s, the genetic roots of bedwetting were targeted in a series of studies published in prominent medical journals. As the source of bedwetting was genetically located, enuresis could be articulated as a physical illness rather than a product of poor potty-training or a symptom of a maladjusted personality. ‘Knowing that a gene is causing the problem should alleviate much of the parental blame and a child’s embarrassment about wetting’, argued one doctor (Goleman, 1995). No longer is bedwetting viewed as symptomatic of a maladjusted personality as the child does not bear personal responsibility for the illness but is actively enlisted in the cultivation of techniques for its treatment. The treatment of enuresis becomes a question of proper management rather than a source of shame.
However, while genetic technology has come to predominate in other areas, enuresis continues to be articulated as an irreducibly physiological, psychological and sociological problem. In its treatment, no single discipline has been able fully to delineate an object of regulation that separates it from previous regulatory technologies and practices. Warning that the gene for enuresis ‘may be a part of a bigger behavioural syndrome’, a child psychiatrist argues in a 1995 New York Times article: ‘Especially with young children you are reluctant to use any biological treatment until you’ve tried behavioural and psychological approaches first’ (Goleman, 1995). And while desmopressin and other drugs have increasingly made inroads among paediatricians, they have often been avoided due to their potentially ‘serious’ side effects. In fact, conditioning treatments derived from behavioural psychology and training techniques taken from modern psychoanalysis continue to play a prominent role in the treatment of enuresis. Moreover, these treatments are increasingly combined in elaborate networks, tying together drugs, alarms, retention control training, monetary rewards, hypnosis, cleanliness training, and a graduated ‘overlearning’ procedure (Mellon and McGrath, 2000: 197).
While emerging technologies have produced an extensive knowledge of the enuretic subject and have extended the body through a wide array of regulatory practices this does not mean that they have become more effective in preventing enuresis. In fact, recent studies have found that it is taking longer for children to toilet-train now as compared with the 1960s (Neff, 1998). As such, the development of technologies for the production of subjectivity is not a linear progression from behavioural and psychoanalytic treatments to the biomedical model. Rather than building on the success of previous technologies, the development of new technologies has been contingent on the failure of any single model to sufficiently define the object of regulation. As Mellon and McGrath (2000: 194) argue, ‘[t]he variability in the etiological explanations for enuresis manifests the heterogeneity in the disorder’.
The heterogeneity of the disorder, the inability to constitute a proper target for treatment, leads to the combination of treatments derived from psychoanalysis, behavioural psychology and biomedicine as well as traditional methods. As a result, the extensive constitution of the body through diffuse and divergent techniques has led to the emergence of an increasingly ‘baroque subject’. The notion of the ‘baroque’ is borrowed from a previous epoch of art and literature that was more concerned with the production of ornate forms than useful implements. However, recent studies have adopted the ‘baroque aesthetic’ in characterizing the culture of late capitalism. As Sanbonmatsu (2004: 73) argues, ‘a baroque aesthetic, characterized by density of expression and frenetic rhythms, has suffused Western capitalist culture in recent decades infecting everything from popular culture and science to literature and video games’. For instance, Mary Kaldor (1981) traces the emergence of a ‘baroque arsenal’ in her study of the evolution and devolution of modern weapons system. For Kaldor, there is an inverse ratio between the significant amount of capital and labour that has become necessary to produce new, high-tech weapons and the diminishing utility of these weapons in combat. As these weapons systems have become increasingly complex and densely layered, their ‘reliability declines and operational costs increase at an exponential rate’ (Kaldor, 1981: 22–5).
Similarly, I have traced the emergence of a ‘baroque arsenal’ for the treatment of enuresis. The proliferation of new technologies should not be attributed to the entrenchment of regulatory knowledge. As Fishman (2004) argues, this process should be viewed as multidirectional, interweaving a wide array of regulatory actors integrating commercialism, science, clinical medicine and government regulation. With the infusion of medical science and corporate capital through the 20th century, the ability of researchers to constitute regulatory knowledge has been called into question. As the average age at which children are potty-trained rises, a wide array of technologies has flooded the market targeting older children. Proctor & Gamble has added a size to its stretch diapers, accommodating children 36 pounds (16.3 kg) and up. The new diapers are advertised by celebrity paediatricians encouraging parents to let their kids toilet-train at their own pace. Their major competitor, Kimberly Clark, launched Goodnites, specifically targeting children with bedwetting problems and offering ‘innovative’ modifications, including race-car prints for boys and pixies for girls as well as odour control in order to hide the embarrassing smell at sleepovers.
In the absence of a specific target for the treatment of enuresis, technologies are not so much focused on cures but rather on coping techniques in which the specificity of the body is lost. The focus shifts from bedwetting as a ‘social and economic hazard’ to bedwetting as a humiliating stigma. Hence, in recent advertisements the stigma attached to bedwetting is heavily emphasized: ‘For him there’s nothing worse than waking up cold, wet and alone. Except waking up cold, wet and surrounded by friends.’ While the stigma was previously located within the interiority of family, it has increasingly been articulated in relationships that traverse heterogeneous networks. With the conceptualization of the body as a surface, this stigma cannot be located in any specific time or place, but rather appears as multiplicity. In this context, the role of the enuretic subject is not to get well but rather to cope; hence, diapers are increasingly presented in the media as a form of treatment, providing the benefits of ‘privacy’, ‘independence’ and ‘confidence’.
Conclusion
In this article, I have examined the historical development of different topologies for the treatment and regulation of bedwetting. Drawing from science and technology studies, I argue that the human body should not be treated as a pre-existing or coherent whole, but is rather enacted in combination with different technologies. I have outlined how the development of different technologies has been predicated on certain assumptions regarding the limits of the human body and how the body can be effectively regulated through a range of regulatory agents.
While naturalistic topologies subsumed the human body under the divine unity of the cosmos, treating bedwetting through the adoption of analogous objects found in nature, with the crisis of filth in the 19th century and the concomitant rise of public health and personal hygiene, the treatment of bedwetting was advanced through the cordoning off of the human body and its organs. The emergence of institutional enclosures was matched by the development of new mechanisms that initially aimed to trap the flow of urine through the partitioning of the human body. Nevertheless, the diagnosis of bedwetting remained elusive, persistently leaking beyond disciplinary boundaries.
The debates in early 20th-century psychiatry revolved around the question of whether bedwetting should be treated as a biopathological problem, to be dealt with through the conditioning of the human bladder, or a psychopathological problem, symptomatic of underlying personality defects. Through the development of behavioural psychology and psychoanalysis, the human body was viewed less as a single object to be restrained and cordoned off, and more in relation to its environment. The treatment of bedwetting through the mattress pad conditioned the human bladder through its integration as a switch in a broader electrical circuit. Likewise, psychoanalysts came to view bedwetting as a problem of the human subject in controlling the external environment to be dealt with through the cultivation of self-management in children.
These regulatory knowledges have provided the foundations for the ‘somatic individual’ that would later solidify with the development of genetic technologies. The various discourses that have been mobilized for the treatment of enuresis reflect to extension of regulatory practices to include doctors and therapists, parents and neighbours, drugs, diapers and mattresses. However, new technologies for the treatment of bedwetting have problematized the boundaries between the body and its environment. With the extension of regulatory practices to incorporate a wide array of diffuse actors and institutions, it has become unclear precisely where the body ends and the environment begins. In this sense, I have shown that recent developments in the regulation of bedwetting reflect a broader tendency towards the emergence of a modern ‘baroque’ subject, in which the singular body gives way to the enactment of multiple bodies as distinct targets for regulation.