Nothing supports the thesis that human consciousness is a recent, flaky, and largely accidental add-on to an otherwise sort of unremarkable primate brain like paruresis.

We would like to pretend that the conscious mind is really in charge upstairs, a high-powered executive writing memos and really synergizing with the body beneath him, bluetooth earpiece in ear and Italian-leather-shod feet on desk, making phone calls and holding meetings with the odd cognitive function but mostly being an autocratic badass and really just killing it, dictating policy and making unpopular but ultimately correct decisions, jetting around in a neurological Gulfstream G550 business aircraft, feared and respected at every turn, the Jack Welch of anatomy.

And maybe some people can maintain this illusion for themselves. But for the paruresis sufferer, the whole idea of conscious-mind-as-body’s-master is completely obliterated by a simple trip to the restroom.

Because the conscious thought of “Okay, let’s pee right into this here urinal” doesn’t just shoot right down to the pudendal nerve, relaxing the urethral sphincter and allowing the paruresis sufferer to micturate in peace. No, there is a series of complicated negotiations that go down, involving both branches of the autonomic nervous system, the bicameral legislative body of human anatomy. Both the sympthetic and parasympathetic systems get a vote, you see, but the sympathetic nervous system has the veto.

To extend this poorly-advised and -informed legislative analogy, this is like giving line-item veto not to the head of the executive branch, but rather to every single member of your voting citizenry, a jumpy and excitable bunch who frankly aren’t well-positioned to evaluate big-picture stuff. There you are, trying to pee, when every Neuron Tom, Neuron Dick, and Neuron Harry has the ability to go fight-or-flight for any reason or no reason at all, up to and including “What if someone comes in the door! What then?!

So what is obviously actually happening is that the desire to just pee in the goddamn urinal is more a non-binding agreement than it is a Welchesque ultimatum, which agreement filters down through an intricate series of neuropsychological levels, any one of which might decide that, nah, fuck it. Whoever it is that gets to pull the lever on urethral sphincter relaxation, it’s not the “self” in any real sense. When it comes to urination, the sympathetic nervous system is a highly insecure and twitchy constituency, and it requires guarantees of absolute privacy. The problem is that it shouldn’t even know what privacy is. It is an exceptionally stupid and instinctive branch of human neurology, but it’s nonetheless smart enough to check in with some part of the higher cognitive functions. However—and this is the crucial part—the sympathetic nervous system is not listening to the part of consciousness that wants to pee. It is instead listening to the part of consciousness that is worried about what might happen during urination.

This is good old paruresis, AKA “shy bladder,” and it comes in a spectrum of severity. While some sufferers’ sympathetic nervous systems are paralyzed into sphincter-clenching inaction by the very notion of a busy row of mens’ room urinals, many of them can find relief in a stall. It’s still a negotiation, but it’s generally one the executive branch can win. For other people—most of whom are boys and men—it can be totally intractable and crippling, requiring a carefully-maintained schedule of home visits and dehydration. Some of them can’t pass drug tests, being physically unable to pee on demand in a cup.1

But further contemplation of this condition only makes consciousness look stranger. Because the sympathetic nervous system seems to be taking at least some of its clench-inspiring cues from insecurities originating in or at least informed by conscious thought, e.g. Does That Guy Have a Bigger Dick Than Me, He’s Sure Peeing Like A Champ, Why Can’t I Do That, What If He Looks At Me, Is My Peeing Too Loud, Is It Too Quiet, etc. So what becomes clear here is that the by-now incredibly labored legislative analogy’s equating of “conscious mind” to “executive branch,” is at least an oversimplification, because consciousness now seems more like the Supreme Court, say, with its own dissenting voices and partisan disagreements, and the self (and but at this point, does it even make sense to assert the singular?) is clearly sometimes staking out the minority position.

And even in the peace and privacy of home, there is always a yea-or-nay vote on micturition. You can’t just fucking pee. You have to stand there, center yourself, relax. Take a couple deep breaths. C’mon, buddy, the sufferer whispers to himself. Let’s do this. For some, the difficulty is as old as consciousness itself, but for others, there is a triggering episode, which must be way worse—the sudden betrayal of a once cooperative nervous system serving to undermine a whole litany of previously assumed confidences.

The paruresis sufferer can’t even count on a baseline level of severity; drunkenness (to pick an arbitrary example) might swing it either way. Given a certain level of inebriation, the conscious mind can be distracted just enough to break the administrative deadlock—a very welcome development, if a fragile one, given that booze can also turn up the severity on a certain personality type’s introversion such that the sufferer stands there, mind turned solipsistically inward as he think sabout how badly he wants to pee, and all the reasons he can’t.

Sometimes the debate is unwinnable. The average paruresis sufferer has walked out of the bathroom more times than he can remember (after giving the toilet a performative flush, of course), grimly determined to pretend as though he’s relieved himself but drinking as little fluid as he can manage until a retreat to the safety of his home bathroom is possible.

He stands in awe of his un-afflicted significant other, who strides confidently into the bathroom and just lets fly in seconds, “Hang on I gotta pee; okay let’s go!”, like it really is just straight-up conscious motor control, no more cause for tense intra-anatomical inter-neural negotiation than lifting coffee cup to lips. They find it hard to imagine what that would be like—but it must be glorious.

Meanwhile, with the neurological body politic so intractably dysfunctional and deadlocked, paruresis serves to undermine the whole notion of consciousness as being a useful cognitive tool. If all your consciousness is good for is processing high-level events like understanding that there’s someone outside the bathroom complaining about how long you’re taking inside it—breaking that high-level input down into the base chemical representation of unease and anxiety—then what is it good for, really, consciousness? And what other conscious efforts to change behavior are similarly doomed?

  1. And of course the irony is that although paruresis seems to have its roots in some kind of low-level instinctual avoidance of embarrassment (or whatever the equivalent of embarrassment would have been for our pre-conscious mammalian ancestors) the inability to pee on command turns out to be way more humiliating than whatever the sympathetic nervous system is afraid of. And but that high-level, conscious embarrassment is still embarrassment, so it gets dumped right back into the neurochemical hopper. So embarrassment about being unable to pee only makes it harder to actually pee, to the point where anticipation of the problem becomes the actual problem. It’s almost impossible to resist looking at this dreadful feedback loop as emblematic of something really fundamentally difficult about the human condition.

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