Posted by Andrew on 23/7/2011, 5:42 pm, in reply to "ESA"
In the absence of any reported experience of the Employment and Support Allowance, I have pasted in some notes I made in December 2008 after enquiring about paruresis at a 'ocal Citizen's Advice Bureau.
It would be worth bearing in mind that in spite of being affected by paruresis, it would be reasonable for the authorities to ask whether treatment had been sought, and a treatment program followed; also it would be reasonable for them to ask whether the use of self-catheterisation had been gone into in order to improve one's employability.
Avoidant Paruresis (Shy Bladder Syndrome) – Disability Discrimination Act
The text comprises extracts from the Income Data Services Handbook on Disability Discrimination. My comments, as agreed with the Citizen’s Advice Bureau, are marked as such.
Definition
A person has a disability if he or she has “a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities”.
Long term
A disability is considered to be long term if:
· it has lasted at least 12 months
· will last at least another 12 months, or
· is likely to last for the rest of the individual’s life.
Comment: This is specific to each individual. It is common to find that the condition began in childhood or in teenage years. Less commonly it can begin in adult life. Individuals have usually had the condition for many years, or decades. It is likely to continue for the rest of the individual’s life.
Physical or mental
Comment: Though the symptom – the inability to urinate in social situations – is physical, the cause of this is mental, being a social phobia whereby the individual becomes severely anxious in the presence, or the perceived presence, or others. This causes the sympathetic nervous system, which is not under conscious or voluntary control, to shut down the urinary system. Thus though the individual wishes to urinate, the body will not allow it to happen. If a location deemed safe by the individual for urination is not found, severe discomfort results, leading to pain, distress and eventual hospitalisation for catheterisation – end of comment
A mental illness must be clinically well recognised. ....which is recognised by a respected body of medical opinion.
Comment: This condition is recorded in psychological reference works (1) as an example of a social phobia. However due to the shame and embarrassment felt by sufferers, they rarely admit to it, resulting in a major proportion of the medical fraternity never coming across a case. However social phobia itself is a well recognised condition.
For this reason, expert evidence is often required.
The Charity’s Honorary Consultant is a Professor who is a chartered psychologist and a registered psychotherapist.
– end of comment
Degree to which the person is affected
Comment: This condition exists across a wide range from mild to severe. Mild cases - i.e. where a male is not always successful at a urinal but can manage in a cubicle - is unlikely to be considered a disability. A severe case – where the individual, male or female, can urinate only at home, and even there can be negatively affected by the presence of visitors – has a self-evidently disabling effect on their ability to carry out normal day-to-day activities.
Due to this range, an individual’s position on the range needs to be determined.
Because of the social triggers to the condition, a person who manages with day-to-day tasks can find themselves effectively disabled by specific situations e.g. being asked to provide a urine sample for a drug test under controlled conditions.
– end of comment
Substantial adverse effect
The emphasis is on the effect the impairment has, not on the severity of the impairment itself.
The fact that the individual can carry out activities does not mean that his ability to carry them out has not been impaired.
Experience shows that disabled people often adjust their lives and circumstances to enable them to cope for themselves. ...... to live on their own.
Comment: Take a severe case of SBS, who can urinate only at home. If away from home in a social situation, or if at home with visitors, he is unable to empty his bladder. If kept in this situation, he would require emergency hospitalisation for catheterisation. This is uncontrollable, and it is mental. If forced into such situations, there would be a substantial risk to his mental health. The anxiety caused by being in such a situation would severely diminish his ability to concentrate on and to perform tasks.
Take a moderate case, who can cope with a social working conditions, but who cannot produce a urine sample for a drug test, and so is threatened with dismissal. In this case the impairment seems slight, but the effect in the specific drug testing scenario is severe, because the potential impact is the loss of his or her job.
– end of comment
Normal day-to-day activities
The DDA Act protects individuals whose ability to carry out normal day-to-day activities is impaired. ....an impairment must affect one of the following: ........continence.......
Comment: Continence is defined as the ability to control one’s bladder or bowel. An incontinent person (an enuretic) has no or little control over the bladder resulting in involuntary evacuation. A paruretic has no or little control over the bladder resulting in involuntary retention.
– end of comment
References
(1) Williams and Degenhardt "Paruresis: a Survey of a Disorder of Micturition" Journal of General Psychology, 1954, 51, 19-29.
UK ParuresisTrust
Registered Charity 1109541
PO Box 182, Kendal, LA9 9AE
376
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