Background to my interest in teaching children with autism

PSYCHOTHERAPY BEYOND THE FRINGE, continued

Three more years passed. Felicity received a frantic phone call from Deryk complaining that his homosexuality was back again. In the meantime, Deryk, his wife and daughter had returned to their original home base, so Deryk could attend appointments in person. Felicity gave Deryk an appointment for a week away, and asked Deryk to come with a record of his bowel movements in the intervening time. He recorded an average of 15 bowel movements a day.

Felicity had never explained to Deryk about the relationship between his homosexuality and his bowel movement frequency. While giving him the new set of timetables, on this occasion he explained what had happened and why — hopefully in a way that Deryk could understand well enough to use the information in the future.

The autonomic nervous system (ANS) has two branches — the sympathetic (arousal, stress, emergency or anxiety) branch and the parasympathetic (calmness, pleasure) branch. Messages are sent out by the brain to most organs along these two branches depending on what the brain ‘wants’ the body parts to do — to get aroused, activated or uptight, or to get calmed down and relaxed. And, by means of its internal (proprioceptive) sensory tracts, the brain receives back information about what the body organs are doing — information which may be experienced by the brain as discomfort, anxiousness or uptightness, or as calmness, comfort or pleasure, respectively.

When the rectal sphincter is closed tightly, that is done by the sympathetic-stress-anxiety branch of the autonomic nervous system; and when the rectum is relaxed or opened, that is done by the parasympathetic-calm-relaxed branch of the autonomic nervous system. Felicity thought that Deryk needed this much basic neurophysiology. But of what importance was this information?

When the bowel is evacuated too frequently, say, more than once or twice a day, it does not have time to do its job of retrieving fluid from the bowel contents. This has two effects. First, it over-taxes the body’s fluid retention system so it has to over-work to retrieve enough fluid. This can result in failure to retrieve enough, and thus in too little fluid retention and loss of weight. Or the over-work can result in excess retrieval, and thus in too much fluid retention and weight gain. Deryk might remember the latter as a difficulty he had experienced each time he had felt he was a homosexual.

Second, it results in relatively fluid bowel contents. This requires the person to keep his rectal sphincter tightly closed — to prevent the social embarrassment of leakage. Maintaining strong tightening of the rectal sphincter creates and maintains a strong sympathetic-anxiety response in the body — in order to achieve and hold the closing of the sphincter. This results in the person feeling a growing sense of anxiety, discomfort and uptightness. Moreover, this tense uptightness is mainly located in the general region of the genitals. Tension around the genitals may increase sexual excitement. If the arousal becomes associated in the person’s mind with the genitals, and thus with sexuality, the anxiety and its local tension may increase the person’s sexual drive and thus the probability of homosexuality (see next section).

Felicity explained that this was why he had asked Deryk to reduce the frequency of his bowel movements each time he had complained about homosexuality. That is, the purpose of reducing the bowel movement frequency was to reduce the fluidity of the bowel contents, so that he would not have to maintain a strong and continuous sympathetic-anxiety response to hold the sphincter tightly closed.

Deryk said he understood what he had to do. He kept in touch with Felicity until his bowel movement frequency was down to one per day, and he reported the loss of homosexual interests with an increased sexual interest in his wife. There has been no further contact during the fourteen years since this last episode.

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