Up Close With Dr. E

Encopresis: A disorder of shame

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Hello readers. Allow me to introduce you to Devon. Devon, I’d like you to meet a group of kind people, my readers. Don’t be afraid, Devon. They will not judge you; I promise.

Compared to other six-year-old boys, Devon is not extraordinary; at least in the sense of possessing Olympian basketball skills like Michael Jordan, skyscraper IQs like Bill “Microsoft” Gates, or Hollywood hunkiness like Brad Pitt. No, Devon is just an ordinary boy.

A boy whose chocolate eyes, unruly brown hair, and disarming grin, makes you instantly like him. Unfortunately, cruel life forces are approaching, and in the same way a wool sweater can be completely unraveled by pulling a loose thread, so too will Devon’s life unravel when the combined forces of guilt and shame bring him to his young knees. But all is not lost. For, unbeknown to anyone, Devon has a secret power. A power soon to awaken. Here is his story.

Devon’s closest friend, William, is his father. They both love the outdoors; camping, hiking and fishing. As his only son, Devon is truly the apple of his father’s eye.

William, a safety engineer for a steel mill, had initially taken his job because it allowed him to be home with his family. That all changed when the economic chaos of the past three years hit the steel industry. William’s new job forces him to fly out to the other 12 steel plants, many located outside the USA. He is now gone 60% of the year, often for six weeks at a time.

Devon’s mom, Pam, is a billing clerk for a large surgery practice, and her commute to work stretches her workday to 10 hours. Tasha, Devon’s sister, treasured her baby brother, until she turned 16. With a car, she is now gone a lot. Brown-eyed Devon is alone.

More attacks ­— Goldie, his one-year-old golden retriever, is run over and killed. Mrs. Temple, his first-grade teacher, who he loves, leaves to have a baby. Change after change after change.

Devon’s life, a castle now besieged, is locked in a deadly battle. The first casualty in this war is Devon’s ability to sleep. His mind, now exhausted, begins to weaken.

The second casualty is his ability to fight off repeated nightmares. Black-winged creatures, half-man, half-beast, commence night maneuvers. As they encircle Devon’s body, acid-venom drips from their stalactite teeth to fall upon and blister his forehead. Goldie, save me!

The final casualty occurs after eight weeks of daily stomachaches and severe constipation: Devon’s brain-bowel sensory feedback loop is disconnected. For the first time since the age of two, Devon begins to have bowel movements in his pants, soiling his underwear.

Encopresis, the medical term for soiling, with its double-headed hammer of guilt and shame, pounds down and shatters delicate childhood structures: peace of mind, security, the sunbeam smile of innocence.

First office visit: I discuss Devon’s treatment plan with his parents. “Encopresis is a stress disorder which stops Devon from feeling a BM coming. His plumbing is stretched too large, due to chronic constipation, so we will re-train his bowel. I just checked with Devon’s physician and good news — no other medical complications. His condition is correctable. But we must reduce all guilt and all shame. Give his teacher an extra set of clothes to keep at school. Set up a private signal, only between Devon and his teacher, so Devon can leave class and use the bathroom to clean up. Tell the kids who call him “Stinko” and “Dumper” to stop.”

Last office visit: “Devon is back to his old self,” his parents remark and thank me. His father speaks up, “I’ve changed my work, I’m just a group leader now ­— a loss of income —  but the sacrifice is well worth it if I can have time with my family.” His mother adds, “I quit my job to attend junior college. I’ve always wanted to be a paralegal — my uncle who is an attorney has been trying to get me to work for him, and I will be able to work from home.” Devon speaks last: “Here is a picture of my new dog, Duke — he is just a puppy.” As I hold the photo, I see Devon feeding Duke with what looks like a cookie, so I ask him about it. “Oh, that’s a peanut butter cookie, my favorite, my mom and sister bake them all the time, now.”

Good story? You like it? What, you want to know Devon’s secret power? OK. All children have a dormant, extraordinary power hidden inside them. In times of hardship, it comes out. We call it resilience.

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.

 

Dr. Richard Elghammer contributes his column each week to the Journal Review.


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