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DEAR SIR,
I should like to offer a few comments on the paper 'Enuresis; A Functional Equivalent of a Fetish' by Victor Calef, Edward Weinshel, Owen Renik and Elizabeth Mayer which appeared in Volume 61, Part 3 of the International Journal and in which certain exceptions were taken to formulations of my own, published earlier (Esman, 1977).
It is my impression that, in relying largely on reconstruction from adult analysis the authors may have confused cause with effect. It is their suggestion that the enuretic child, suffering from severe castration anxiety, creates a defensive split in the ego, such that the enuretic act is a 'functional equivalent of the fetish' and that 'the urinary stream itself actually served as a fetish'. The implication here is clearly that the enuresis represents a pathological solution to a condition of intense castration anxiety derived from, among other things, viewing the maternal genital, seeing the genitals of a baby sister, etc. The authors do not have appeared to have considered the possibility that the enuretic child, suffering from a maturationally determined impairment of control capacities, experiences himself as damaged, defective and inadequate—i.e. castrated, and that the various representations of this self-image that emerged in the later analytic work with their patients may thus have been the consequence rather than the cause of the child's enuretic disorder. Were this to be the case, of course, (as I believe it is) this would cast some doubt on the validity of their reconstructions.
A second issue has to do with their apparent failure to distinguish between primary and secondary enuresis. In at least two of their cases, the problem appears to have been clearly of the secondary variety in which the enuresis developed after a prolonged period of nocturnal urinary control. There is little doubt that such conditions occur in response to traumatic or stressful experience in the child's life and that they may well be a respo