Commentary: Treatments for Enuresis: Criteria, Mechanisms, and Health Care Policy

Abstract

We are fortunate to have the case of treatments for enuresis to teach a historical lesson about the pitfalls of our current enthusiasm for empirically supported treatments. The treatment of enuresis has a long and very colorful history dating as far back as 1550 B.C. Glicklich (1951) recounted two instructive examples of “treatments.” In West Africa, children who wet the bed were “treated” by attaching a large frog to their waist, and this apparently frightened them into being dry. Among the Navaho tribe, one preferred treatment was a ritual that required enuretic children to stand naked over a burning bird’s nest, and this was believed to produce a cure of bedwetting because birds did not soil their nests. We may snicker at these practices of the past, but the laugh is really on us. These practices worked, and they worked on a variable interval schedule of reinforcement because they were occasionally followed by the spontaneous cessation of bedwetting, something that happens for about 16 out of every 100 children within a 12-month period. It is no wonder then that so many peculiar treatments have been tried, and so many odd practices have persisted. In some ways what we really need to know about treatments for bedwetting is which treatments definitely do not work. Such a Popperian approach to the issue of identifying empirically supported treatments is counterJournal of Pediatric Psychology, Vol. 25, No. 4, 2000, pp. 219–224