By Steve Hodges, M.D.
In my capacity as a pediatric urologist, I don’t have much to say about politics, except this: I wish political operatives and pundits would retire “bedwetting” from their professional discourse.
I have never been a member of the language police — far from it. However, political use of "bedwetting" perpetuates myths about actual bedwetting, known in medical parlance as enuresis. As the term infiltrates political commentary, it contributes to the very real shame and blame my patients internalize, by implying that wetting accidents are voluntary and triggered by stress — which they are not.
Every election cycle, the term proliferates in the mainstream media. I know this because I’ve set a Google Alert for “bedwetting” to track public perception of a condition I treat daily. Mixed in with articles about mattress protectors and child abuse (“Father sentenced to 28 years for beating 3-year-old son to death over bed wetting” or "Texas Woman 'Tortured' 6-Year-Old Twins, Killing One Over Bed-Wetting") are stories analyzing Democratic and Republican electoral prospects.
Political use of the term dates back at least to 1980, when the Modern Legal Glossary defined “bed wetters” as slang for young Congressional Democrats “who panic easily when things don’t go their way.” These days, "bedwetting" is commonly deployed by high-profile journalists and commentators of all political stripes, folks I hope would stop using the term if they understood its harms.
A few recent examples:
•Democratic strategist James Carville told CNN: "Democrats need to quit bedwetting. My Wife has already changed me to rubber sheets."
•A Tampa, Florida, news outlet reported "Rep. Matt Gaetz Of Florida Says ‘K-Street’ Is Bed-Wetting Over House Speaker Mike Johnson."
•The San Francisco Chronicle headlined, "Democrats are ‘bed-wetting’ even amid electoral wins. Is the anxiety justified?"
•The Washington Monthly published "A short history of Democratic pre-election bed-wetting."
•MSNBC anchor Jen Psaki wrote:“But all this talk of Democratic anxiety really just makes me wonder — where’s the Republican bed-wetting?
•On Pod Save America, co-host Jon Favreau said, "Here’s my thing on the bedwetting." A few weeks later, co-host Tommy Veitor said it was unfair to expect Democrats to "stop bedwetting" because "Everyone’s allowed to feel a little anxiety."
•New York Times political columnist Michelle Cottle wrote that climate change “remains a favorite culture war cudgel for Republicans, slamming Democrats as a bunch of bed wetters wrecking the economy.”
“Bedwetting” has become such a cliché in politics that the term even rates an entry in Taegan Goddard’s Political Dictionary, referring to “excessive worry about a political outcome.”
What’s the big deal? Well, linking “excessive worry” to urinary accidents reinforces a widespread and damaging falsehood: that enuresis is caused by stress or anxiety — that kids could stop bedwetting if only they would chill out.
In fact, enuresis (which includes both nighttime and daytime wetting) is caused by chronic constipation. X-ray any child with enuresis, and you'll find a rectum clogged with stool. The enlarged rectum aggravates the nearby bladder nerves, causing the bladder to contract forcefully and empty without warning. Anxiety, stress, or behavioral issues play no role.
Yet the notion that enuresis has psychological roots has persisted for centuries and is pervasive in popular culture. In TV, film, and books, bedwetting portends psychological distress. Inevitably, the kid who wets the bed is the one neglected by Mom! (See: Borgen, Fleishman is in Trouble.)
In the popular press, too, it's just assumed that bedwetting has an emotional component. In a recent New Yorker article, about one woman's harrowing confinement in an Austrian institution run by a cruel and twisted psychologist, writer Margaret Talbot observes:
In the early twentieth century, a punitive approach to bed-wetting was common, including in America. Most experts gave little credence to the many developmental, physical, and emotional issues that cause a substantial minority of children to wet their beds past the toddler stage.
It's true that a substantial minority of children wet their beds past the toddler stage. It is not true that "many developmental, physical, and emotional issues" cause these accidents. Emotional issues have no bearing on enuresis. Developmental issues play very little role. (Autistic kids bear the brunt of this misconception.) And with rare exceptions, physical issues other than chronic constipation also play no role. (I discuss these rare exceptions — mainly neurological conditions, such as spina bifida or tethered cord syndrome — in the M.O.P. Anthology.)
However, I do understand why the media, pop culture and political pundits get this wrong. They are simply taking cues from erroneous psychiatry and psychology texts.
Unbelievably, the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes enuresis as “voluntary or involuntary” and cites “predisposing factors” such as “psychosocial stress.” The Handbook of DSM-5 Disorders in Children and Adolescents links daytime wetting to “difficult temperament and maternal depression/anxiety” and attributes bedwetting recurrence after a long dry period to “stressful life events,” including parental divorce. And according to Psychology Today’s “Diagnosis Dictionary,” wetting accidents may signal "a child has deep feelings they’re struggling to express or a need for attention and care.”
The studies cited by mental health texts in support of an alleged psychological link are deeply flawed and misinterpreted.
In reality, enuresis is not voluntary and is not caused by stress, attention seeking, neglect, or parental divorce. Enuresis is no more a mental disorder than an enlarged prostate and does not belong in the DSM-5 or in political rhetoric.
Sure, children with enuresis experience stress, anxiety, even serious depression. That’s because these kids miss out on sleepovers and sports camps and feel terrified their friends will discover their pull-ups.
A 15-year-old honor student and athlete with enuresis recently emailed me: "My dad screams about how I’m not a little kid anymore. He wants me to sleep in a wet mattress to learn what ‘discomfort is’ and how disgusting I am. He has tried punishments like taking away my electronics and my breakfast."
Bedwetting causes anxiety, not the other way around. So, when political pundits jokingly use the term "bedwetting," it only reinforces the misconceptions that heap stress on my patients.
The good news: Unlike the angst of political operatives, enuresis is entirely treatable. When the rectum is fully evacuated every day, it shrinks back to size. The bladder nerves recover. Wetting stops.
Unfortunately, countless children miss out on these treatments because their bedwetting is presumed to be psychological. Kids with enuresis are frequently referred for behavioral counseling, plied with sticker charts and bribes, even prescribed psychiatric medication — when all they need is treatment for a clogged colon.
Every time political operatives scold their party for “bedwetting,” I think of my patients who have been scolded, blamed, or teased for a condition that is totally beyond their control.
I try hard to persuade my patients that accidents are not their fault. When I hear pundits joke about "bedwetting," I resolve to try harder.