Sunday, April 11, 2010

Stuttering Treatments of the Past

In a 1992 article in the Journal of Fluency Disorders, Charles Van Riper told of how he and fellow graduate student Wendell Johnson served as experimental white rats at the University of Iowa during the early 1930s.

"Our brain waves were checked; needles were inserted into our tongues and the nervous impulses recorded on the smoked drum of a kymograph; we took various drugs - cocaine, hashish, mescaline to see how they would affect our speech."

Now there's some interesting research. Not the needles in the tongue part - the other stuff.

Saturday, April 3, 2010

The Bates Appliances - 1851

Guaranteed to work first time, every time.

Monday, March 22, 2010

Go Taboo Yourself

The following passage comes from George H. Shames and Herbert Rubin in the book Stuttering: Then and Now.

"Talking about stuttering is a social taboo. Even in households with disfluent children, overt commentary is the exception rather than the rule. Taboo subjects tend to surround themselves and the members of the problem with a sense of shame and guilt which, together with a sense of victimization and helplessness, can continue through adolescence into adulthood.

For adult stutterers the social ritual proscribes any comment about disfluent speech, with the possible exception of the stutterer himself, in the form of a joke or an excuse. Neither the family nor friends risk the embarrassment of commentary, as if they were confronting the emperor without his clothes, conspirators in denial."

This is a remarkable statement. Let's look at your average stutterer: filled with guilt and shame, helplessness and a self-pitying victimization, making jokes or excuses for their behavior. And the stutterers family and friends? They can only feel embarrassment when faced with such a person.


I'm 55 years old. As a child, my parents rarely talked about my stuttering. Not out of a sense of embarrassment, but because there was rarely anything to talk about. What would you say to a blind child - "How's the lack of sight going?" If I wanted to talk about my speech to my parents, I did so. Otherwise, they treated me like a son, not a stutterer. I knew I stuttered, they knew that I stuttered, and we all dealt with it. There was no taboo, no guilt, and no shame. I was often frustrated, but certainly never thought of myself as a victim, and helplessness never entered my mind. I stuttered - I wasn't paralyzed in a bed.

As to friends - I can't say what was in their minds. but as with my family I rarely discussed my stuttering with them. No denial, no avoidance, no shame or guilt. Just a simple principle - it wasn't there problem, it was mine. To be a friend - or a girlfriend - was to be a person who could deal with it. If a person found it embarrassing to consider, then I assumed that they would not choose me as a friend.

Within the Stuttering Industrial Complex, there is a strong contingent that loves to talk about fear, guilt and shame. And anxiety... don't forget anxiety. I've certainly lived with the fear of stuttering, but the fear was situational. I didn't spend my childhood living in fear, and my adult life has been remarkably ordinary. Guilt? Why in the world would I feel guilty? Stuttering is a pain in the ass - not a sin or a crime. As to shame, there's been some of that over the years, but again it was always situational. At my worst - those memories that stay with me to this day - the feelings of shame experienced when stuttering were generally gone the next day. As with a broken leg, you remember that it happened, but you don't remember the pain.

It is my impression that the people who want to peddle guilt and shame to stutterers belong to the school that holds psychology at the heart of stuttering. And they need fear, guilt and shame to motivate the condition. Are there stutterers who see themselves as victims? Pathetic, self-hating creatures surrounded by pitying observers? I'm sure they're out there. I'm also sure that many stutterers are well-balanced people with no need to wallow in the misery expected of them by stuttering "experts."

Friday, March 19, 2010

Stuttering Technology - 1955

The Stammercheck. Don't wait - order now!

Friday, March 12, 2010

The One Percent Challenge

There have been many proposals for the cause and nature of stuttering. From thick tongues to parental misdiagnosis and brain mis-wiring, the history of the topic is littered with a long list of hypothesis, from the ridiculous to the reasonable. Too often in the past, these proposals were made with little knowledge of the condition, and supported without any effort to test them against observations.

There are certain observations that are repeated throughout the stuttering literature. Stutterers are fluent when speaking in unison with others, anxiety triggers stuttered speech, many children recover from stuttering at an early age, etc. Any hypothesis proposed to explain stuttering needs to account for these, and other observations - the hypothesis cannot conflict with the facts as we know them.

Of the most significant facts of stuttering is that approximately five percent of children go through a period of stuttering, and approximately one percent continue to stutter through their lives. Any proposed cause or explanation must be consistent with these numbers.

We can start by asking whether the numbers are correct. Over the last 100 years, there have been many estimates of stuttering prevalence. Although it was once claimed that some cultures did no have stutterers or words for stuttering, it is now believed that every culture in the world knows stuttering has has stuttering members.

Beyond the existence of stuttering, we could question the one percent prevalence of stuttering adults. While good numbers are not available for every tribe, clan and ethnic group, we can still say something about the prevalence of stuttering is such populations. There is no group in the world in which the prevalence of stuttering is thirty percent. In other words, there is no population in which stuttering is absent, and none is which stuttering is dramatically higher than one percent. We can say with reasonable confidence that if there was a culture in which stuttering was much more common than one percent, we would probably know about it.

So let's take the one percent estimate, and use it as a first approximation test of stuttering hypothesis. Early in the twentieth century, the influence of Freud was strong, and psychoanalytic theory was used to propose that stuttering resulted from oral-sadistic tendencies (whatever that means). We can ask, if it is true that such tendencies develop during early childhood, is it plausible that they occur in one percent of children across dramatically different cultures on different continents? Does that pass the sniff test? Different religions, different family structures and different child-rearing practices would all have to produce this same condition at the same rate. It's hard to imagine that even the confirmed Freudian of the 1920s would actually maintain such a belief when confronted.

We can ask the same question of any behavior-based hypothesis. Whatever causes the behavior - parental disapproval of normal disfluency, mistaken self-judgement of speech competence, etc, Is it plausible that this very specific speech disorder could be produced at the same rate throughout the many different cultures of the world by these methods? If the origin of stuttering were based entirely on environmental causes, why would different environments not produce different results? Do high-income parents in the United States raise more (or fewer) stutterers than working poor parents? Do rural residents produce more stutterers than urban parents? Church-going versus non-believers? Jews versus Baptists? As far as I know, the answer to all these questions is no.

Stuttering has a long history of being the square peg that is pounded into the latest and most fashionable round hole. The rise of Freudian psychology made stuttering the result of a neurosis. Learning theory made stuttering the result of classical, and then operant conditioning. In each case, true believers of new schools of psychology looked at human behavior - including stuttering - through the tinted lenses of of their belief. In a sense, each school of psychology is an ideology. That is, they follow the logic of a single idea. The more aspects of the human condition that can be explained by the theory, the grander it becomes. In many, if not all cases, those taken by the logic of a particular psychological idea seem to have staked a claim to stuttering as their own, without first testing whether their theory was consistant with the knows observations of the condition. If they had done so, decades of wasted effort could have been saved.

Knowing that across cultures, social conditions, place and time, one percent of children become persistent stutterers, it is inconceivable to me that the cause of stuttering could be found in something as variable as parental - or child's own - attitudes. As phrased above, it just doesn't pass the sniff test. In science - indeed, in rational thought - we accept that which is provisionally most likely, and reject what which runs afoul of what we hold certain. With stuttering, this fundamental principle has not been followed. Favored theories have been proposed in sequence, without regard to what are sometimes called "the facts on the ground." Entire careers - and the careers of student/followers - have been built on foundations fatally flawed. The fact that so few people have pointed out these obvious flaws is an indictment of the field as a whole.

Sunday, March 7, 2010

Fill in the blanks

Here's a little test for you. Fill in the blank at the beginning of each sentence. Don't take too long - just come up with something that seems to fit the definition. The result will not count towards your final grade. ;-)

1. ____ is a morbidity of social consciousness, a hypersensitivity of social attitude, a pathological response. 2. ____is the result of conflict between opposed urges to speak and to hold back from speaking. 3. ____ is the disorganization of normally fluent speech that is a consequence of conditioned emotion. 4. ____ is a symptom of an emotionally disturbed personality that profoundly affects the physical, mental and emotional life. 5. ____ is a habit of making elaborate preparations for speech on the assumption that it is a difficult and treacherous process. 6. ____ is an anticipatory, apprehensive, hyptertonic avoidance reaction. 7. ____ is a psycho-neurosis caused by persistence into later life of early pregenital oral nursing, with oral-sadistic and anal-sadistic components. 8. ____ is to speak or say with involuntary pauses, spasms and repetition of sounds and syllables.

Did you guess that the answer to the first definition was stuttering? How about the second? The third? Yep, the answer to all eight definitions is stuttering. The first seven definitions were taken from the following experts in stuttering by Marcel Wingate in his book Foundations of Stuttering: J.H. Fletcher, 1958, J.G. Sheehan, 1953, E. Bruten & G. Shoemaker, 1967, M. Gifford, 1958, O. Bloodstein, 1984, W. Johnson, 1948, I. Coriat, 1958.

The final definition was taken from Webster's New World Dictionary. Now go back and look at those seven definitions generated by "experts" and compare it to the dictionary definition. Doesn't the general-use dictionary make more sense than the expert definitions? Of the expert definitions, one, four, five and six don't even mention speech! Wouldn't you think that a definition of stuttering would at least mention speech, if not, you know, stuttered speech? Numbers two, three and five could refer to any anxiety over speech, such as stage fright. When Marcel Wingate gave this test to his speech pathology class, very few were able to come up with correct answers.

The truth is that these "definitions" excepting the plain-English dictionary offering - are actually efforts to rationalize certain theories of stuttering. All of them are psychological in nature. Some are still popular today. If I could do one thing for stuttering therapy education, I'd make every young prospective therapist get the final, dictionary definition tattooed somewhere on their body. Just so they don't forget, stuttering is stuttering.

Friday, March 5, 2010

Stuttering Technology - 1912

If anynoe knows how this device was supposed to work its stuttering therapy magic, I'd love to hear about it.

Tuesday, March 2, 2010

Charles Van Riper on "being willing to stutter."

Charles Van Riper was probably the most important stuttering therapist of the twentieth century in the United States. His methods have been adopted widely, and his books and other writing were highly influential. A recording of an interview he once gave is available here linked to the words "this interview."

"...these therapists who suggest that stutterers be willing to stutter.... I think that's outrageous. It asks the impossible. On the other hand, you can ask them to study what they're doing, to learn how to change what they're doing, and to find an easier way to respond to the fear of stuttering or to the feel of stuttering. If, when fear comes, he doesn't just panic, but he tackles that word carefully, if a moment of stuttering comes, he finds an easier way out of it, making faces, all of the unnecessary things that he's learned... you can be willing to work, but you can't be willing to stutter, I think. [my emphasis in bold]

Van Riper saw stuttering as an affliction to be confronted and overcome. I find it interesting that some speech therapists today use Van Riper's techniques, which are based on Van Riper's understanding of stuttering, yet seem to be more interested in the confronting and "accepting" than in overcoming.

Saturday, February 27, 2010

Marilyn... Meet Winston

If you are a stutterer, you've seen the lists. Famous stutterers. Actors, singers, politicians and athletes. Here we have two who make every list, Marilyn Monroe and Winston Churchill. I'll leave aside the degree to which the two actually stuttered, and what this should mean to stutterers, and make another point.

Has anyone under the age of 40 actually sat through a Marilyn Monroe movie? The poor thing died in 1962 - I seriously doubt most post-baby-boomers know anything beyond the name and a few iconic photos. And Churchill? I fear that most recent American high school gratuates probably can't say what he's famous for.

If you're going to go the Famous Role Model route - which I see little sense in - I think you need to get off the historical figures bandwagon and find some more contemporary examples. As it is, I find this lists depressing in that with 3 million stutterers in the United States, so very few can be found as role models.

Wednesday, February 24, 2010

I dunno..... (really?)

I became familiar with Robert Quesal, Ph.D. through the podcasts. A quick search found his own web site, which linked me to the following article:

The Role of the Stutterer in Therapy

An examination of that article would extend far beyond a single blog post, so I'll start with one sentence.

"When we observe people who stutter, we have no way of knowing, for sure, which disfluencies that we are seeing are "stuttering," and which are the same types of disfluencies that anyone would exhibit."

First, let me point out that Dr Quesal sees the need to put the word stuttering in quotation marks, as if he were adding a parenthetical "so-called". Second, and rather more important, Dr Quesal tells us that as a Ph.D. in speech pathology, and over 25 years experience, he is incapable of recognizing stuttering when he sees and hears it.

Stop and think about that.

Now let's put on our common sense hats. I think it's fair to say that Dr. Quesal knows stuttering when he sees and hears it perfectly well. In fact, I think it's fair to say that you don't need a Ph.D. to recognize stuttering - any person taken off the street could do nearly as well as Dr. Quesal. People either stutter, or they don't. There was no qualification in the quote above for very mild stuttering, or for stuttering we get away with occasionally. The quote begins "When we observe people who stutter..." No qualifier here - this is meant as a statement of general principle.

So why would an "expert" in stuttering say that he can't recognize the fundamental fact of his field when we believe that that statement can't possibly be accurate? An answer, ironically (or not) comes from the late Marcel Wingate, who was paraphrased disapprovingly in the article cited above. Wingate railed against the tendency to obscure the nature of stuttering by some researchers, particularly Wendell Johnson of the University of Iowa.

This obscuring comes about through the introduction of the idea that stuttering is just another form of "disfluency." These days, it's hard to read a paragraph on stuttering without finding the words fluency or disfluency at least once. This focus - or misdirection - on disfluency just serves to take the spotlight off the matter at hand: stuttering.

This confounding of stuttering - a very special speech disruption - with what is called "normal disfluency" is at the heart of the problem. When stuttering becomes not just "stuttering," as it is understood by most people on the planet, but every hesitation, repeated word and slip of the tongue, then the quote above can be twisted into making sense. Yes, people who stutter do hesitate like normal speakers, and that hesitation cannot be separated out from the hesitation of a non-stutterer. So in that sense, the quote follows its own logic.

The problem with the quote above - the reason it fails so dramatically in a common-sense way - is that when Quesal uses the word stuttering, he doesn't mean stuttering. He means stuttering and all that other stuff that is not stuttering, but I'm putting it in the same bag with stuttering.

Wouldn't it make more sense to restrict the word stuttering for when people actually, you know, stutter? Have you ever listened to a person who didn't stutter speak and think to yourself "I wonder if those are stutters, or just stutter-like normal disfluencies?" I haven't. When someone stutters, I know it. When someone doesn't stutter, I know it. I claim no special knowledge, and I certainly don't have a Ph.D. in speech pathology. No one almost-stutters. A stutter is a unique product of speech pathology. It would be nice if experts in the field kept the definition of the essence of the condition to the actual thing itself, and not obscure it by adding a grab-bag of non-essential phenomena.

Tuesday, February 16, 2010

Stuttering and Social Anxiety Disorder

Please go read the following article on stuttering and social phobia, and come right back (it's better for you to read this short article than for me to quote liberally from it - and links are what the Internet is all about).

What is Stuttering? -- defining stuttering from the speaker's viewpoint, by Mark Irwin

So Mr Irwin is concerned about what he describes as social phobia, or Social Anxiety Disorder (SAD). Anyone who stutters knows that there is more to the experience than verbal disruptions. Irwin suggests a new term, Stuttered Speech Syndrome, to encompass both disfluency in speech and the negative emotional, behavioural and attitudinal reactions that can go along with it. I appreciate his intention, but question his method.

Personally, I'm in favor of having a term that encompasses all the symptoms of stuttering, including both the "stuttering moment" and any of the common but variable psychological baggage that goes along with it. I do, however, have a problem with terms like social phobia and social anxiety disorder. Let me explain why with an analogy to agoraphobia.

Agoraphobia is defined as a fear of public or unfamiliar places. While the exact definition may be disputed, I think that it is fair to say that people with agoraphobia do not suffer panic attacks in public places because they have been beaten bloody at the park. They suffer a generalized anxiety when confronted with a situation that is unfamiliar, out of their control, or where they would feel no where to hide or retreat. To say it another way, their anxiety is not rational in its basis or degree.

The negative emotional, behavioural and attitudinal reactions associated with stuttering, on the other hand, are of another class. They may become irrational in their degree, but they can hardly be said to without rational basis. There is a very real social stigma to stuttering, and I would hardly call the normal response to that stigma a phobia. It seems to me that there is a difference between a fear and a phobia. If I hang you off the edge of a 10-story roof by your ankles, your response is fear, If you won't look out a tenth-story window, that's a phobia.

This is not to deny that fear and anxiety can play a large part in the life of a stutterer - I know it myself. Yet many tests over the years have shown that stutterers are not different from non-stutterers in measures of psychological adjustment. Stutterers are not neurotic - or at least not more neurotic than non-stutterers. Attention to speech-related anxiety seems reasonable if not obvious. Even rational fears can be exaggerated over time until the outcome is far out of proportion to the cause. I just don't see the value in conflating fear produced by an objective, very real stimulus, with a general fear of being judged by others.

If the magic pill that cures stuttering were invented tomorrow, would we still need to talk about stutter-related social phobia?

Social anxiety disorder

Thursday, February 11, 2010

Stuttering Talk Makes My Head Explode!

I've taken the following paragraph from Straight Talk on Stuttering, by Lloyd M. Hulit. Please read it, and then I'll comment on it.

"Wendell Johnson popularized what is called the Anticipatory Struggle Hypothesis, which hypothesizes that the stutter stutters because he anticipates that he will have difficulty saying a particular word, and he tries very hard not to fail, as he believes he will. The struggle not to stutter results in the behaviors we recognize as stuttering. In trying to explain why anticipation is not perfect and why some stutterers seem not to anticipate at all, Johnson and others have suggested that anticipation may sometimes operate at a very low level of consciousness. That is, the stutterer might anticipate without being aware that he is anticipating. While this may seem a specious argument to some, I find it convincing. I suspect we have all experienced situations in which we think we are feeling little or no anxiety about something we must do, only to find ourselves relieved when the doing is completed. The relief is evidence of the anxiety we felt, anxiety we did not know we had. I am convinced, based on my own stuttering experiences and on the experiences of my clients, that stutters often anticipate when they are not acutely aware they are anticipating. One only needs to look at the stutterer's face to see signs of anticipation, signs that often appear before words are spoken. Eyes widen. Lips become rigid. Breathing stops. Whether or not the imperfections between anticipations and stuttering can be explained to every one's satisfaction, the Anticipatory Struggle Hypothesis is widely accepted as an explanation for why certain words are stuttered more often that others" (p. 41).

Sometimes, don't you feel like your head is just exploding? I do. Dr Hulit, Ph.D., is a fan of the late Wendell Johnson. In this case, he cites Johnson's proposal for the cause of stuttering. Johnson believed that stuttering wasn't stuttering until parents - and others - called it stuttering. That is, stuttering begins when parents misdiagnose their children's normal disfluency as deviant, thus provoking anxiety in the child, and setting off a chain of results that become persistent adult stuttering as we know it.

Johnson's Anticipatory Struggle Hypothesis, like any such general hypothesis of cause, has to explain all of our observations about the phenomenon. That is, the proposal has to be consistent with what we know for sure - it can't conflict with solid evidence. In this case, all agree that in many cases, stutterers do stutter exactly on words they fear, or when speaking to an authority figure, or when required to speak their names. All of this behavior is consistent with the anticipatory struggle hypothesis - the stutterer knows what is coming, and has opportunity to become anxious, and the anxiety can trigger the stuttering exactly as feared.

It is also known that many stutterers do not stutter when alone, or talking to pets, or in other situations in which there is no performance anxiety to trigger struggle behavior. This, too, supports Johnson's hypothesis. However.... there are problems. As Hultit acknowledges above, there are times when stutterers stutter in spite of no evidence of anticipation. Or as Hulit puts it, anticipation is "not perfect." Hulit cites Johnson and others proposal that "the stutterer might anticipate without being aware that he is anticipating."

This is where my head explodes!

There follows a twisting, backbreaking attempt to save the hypothesis. First, the word "anticipate" is redefined. The conscious experience of anticipation, which is the whole justification for the hypothesis, now works on a subconscious level. No evidence is presented to support such a suggestion, just rhetorical arm-flapping.

"I suspect we have all experienced situations in which we think we are feeling little or no anxiety about something we must do, only to find ourselves relieved when the doing is completed."

Actually, no. I don't know what he's talking about.

"One only needs to look at the stutterer's face to see signs of anticipation, signs that often appear before words are spoken. Eyes widen. Lips become rigid. Breathing stops."

Of course the signs often appear before words are spoken - the poor soul is anticipating - consciously!

"Whether or not the imperfections between anticipations and stuttering can be explained to everyone's satisfaction, the Anticipatory Struggle Hypothesis is widely accepted as an explanation for why certain words are stuttered more often that others"

First, we're not talking about "imperfections," It is a demonstrable fact that stuttering can and does occur when there is no opportunity or evidence for anticipation. Any general hypothesis for stuttering has to account for all the evidence, not just some of it. Second, widely accepted by whom? Is this an appeal to authority? Don't tell me that someone accepts it - prove it to me. Third, now the hypothesis is for why "certain words are stuttered more often that others." When the hell did a general hypothesis for stuttering become limited to "certain words?"

The worst part of the entire effort is this:

"While this may seem a specious argument to some, I find it convincing."

In other words, he knows exactly what he's doing, but he does it anyway. This was the precise point my head exploded. So you know what you're saying has no basis, but you're sticking with it? No doubt, I am not the first to make this point. I'm sure that Hulit acknowledges the obvious flaw in the hypothesis because it was pointed out by other long ago.

When students enter graduate school in the sciences, many are asked to read classic essays on the practice of science. One of these classics warms against falling in love with a favored hypothesis. Instead of developing - or learning - a favored explanation and defending it to the last, you are admonished to always be ready to allow the evidence to change your mind. There's a seductive danger in signing on to a particular hypothesis - once you invest yourself it its truth, it can be very difficult to say those three scary words - I - was - wrong. All evidence against the favored hypothesis is denied or explained away - like non-anticipated anticipation. Luckily for me, every time my head explodes, the pieces return to their proper place and I can return to thinking the next day.

Sunday, February 7, 2010

Book Talk - Understanding Stuttering

As I read to inform myself and gather material, I'd like to pass on my opinion of various books - a sort of a Consumer's Report for stuttering books, if you will. I'll start with Nathan Lavid M.D.'s small book Understanding Stuttering (2003). At 75 pages of text, plus appendix, glossary and bibliography, it's an easy read, and is written for a general audience. Chapters are: 1. Stuttering Defined, 2. Who Stutters, 3. The Biology of Stuttering, 4. Treatments of Stuttering, and 5. Searching for a Cure.

Such a small book has the virtue of getting to the point quickly, and the vice of not always making its point properly. The first two chapters do the job reasonably well for the general reader not familiar with stuttering or the stuttering literature. The third chapter, The Biology of Stuttering does rather well for its size, discussing relevant brain structure and language-generating areas, brain imaging research, pharmacology and genetics.

The fourth chapter, Treatments for Stuttering, is a disappointment. There is a discussion of brain plasticity and the much-discussed factors that induce fluency (choral speech, singing, adaptation, etc), but the only look at actual speech therapy we get is the author's own practice of Cognitive-behavioral therapy. Nothing on fluency shaping, Van Riper's stuttering modification or operant behavioral practice. After four and a half pages, he goes on to pharmacology and examines various drugs that have been used to treat stuttering. Rather a disappointment there.

The final chapter - Searching for a Cure - is all of seven pages long, and offers little of substance.

All in all, I'd rate it worth borrowing from the library - as I did. The content seems to be reliable as written, only suffering for what it lacks. For those with little time or lacking the inclination to dig into the stuttering literature, this would be a good start.

I'll give it Three Stars out of five. Some good content, but not not long enough to cover the topics properly. In the case of the therapy section, entirely unsatisfactory.

Wednesday, February 3, 2010

To Control or Not to Control.

Out of Control.

In an earlier entry, I cited the following quote from long-time speech therapist Barbara Dahm: "My firm belief is that people stutter when they are exercising control over speech processes that are meant to function on an automatic mode.” A long and fruitful discussion earlier this week has caused me to revisit this quote sooner than I would have expected. I'd like to suggest that the statement above is not only wrong, as in backwards, but it is inside-out as well, if such a thing is possible.

Let's look at a typical stuttering event. A stutterer says "My name is P-P-P-P-P-........P-P-P-P-P-P-P..... aul." Throughout the rapidly repeated "P" sounds, the speaker has shown tenseness in the facial muscles and an abnormally strong breath exhalation on each "P" effort. One could say that these tense, strained and unnatural efforts are part of the maladaptive "exercising control" that Ms Dahm speaks of above. This is a plausible explanation - let's see if it is the best explanation.

Stuttering is immediately recognized as wrong by the speaker at an early age. The stuttering literature gives many examples of young children straining in self-knowledge at their inability to speak works naturally and effortlessly. Certainly, adults are fully able to recognize their own disfluency, even if sometimes they can block it out.

In the example above, the stutterer begins to say his name, and falls into a stereotypical repeat pattern. We might say, for Ms Dahm (if we understand her correctly) that upon reaching his name, the stutterer has assigned to conscious volition a physical/mental process that can only be accomplished by sub-conscious, non-volitional control systems. Again, this is a plausible proposal. Now, let's look at it from another direction.

I will propose here that something very different has happened. The strain and other non-natural behavior seen in stuttering is not found in fluent, non-stuttered speech, and can be seen as - and may, in fact, sometimes be - volitional. But let's go back to the "stuttering moment" above and read it in a different way. The speaker begins his sentence, reaches his name, sounds the "P" and blocks. He knows from experience that this will lead to a series of repeats - the stereotyped stuttering. If he wanted to "take control," what would he do? He might push harder, in some sense, as stutterers so often do. This just increases the tension and anxiety level, and provides positive feedback to increase the stuttering, as Ms Dahm's model might suggest. Here is where I differ.

To gain control, the stutterer always has another choice. He or she can simply stop. Stopping is the ultimate control. If you don't want to stutter, you can always just stop, rather than falling into the stereotypical stuttering pattern. In the hypothetical sentence above, the speaker could say "My name is P-..... aul," or "My name is P-P-P-..... aul. In either case, as soon as the stuttering event is triggered and started, the speaker recognizes it as soon as possible and simply stops. This form of control would not stop the stuttering impulse from occurring, but it has the capability of lessening the symptom dramatically. So why don't stutterers do it? Why don't they even try to "exercise control" and remove themselves from stereotyped pattern or repeating or prolonging that is experienced as so painful?

So here is my counter-hypothesis to that of Ms Dahm. The stutterer doesn't stutter because he/she seeks to take control of the natural, sub-conscious speaking process; the stutterer stutters - in those stereotypical repeats and prolongations - because he or she instinctively seeks to give up control of the disfluency impulse to the (flawed) natural, automatic process. That is, the stutterer does the counter-intuitive - repeating the same letter-sound over and over, in an unsuccessful attempt to move on to the next sound - because he is under a natural compulsion to let the automatic process do its proper work.

Human speech evolved over hundreds and thousands of generations. We learn language and speech naturally, without any conscious effort of teaching, and without conscious effort on our own part to "learn." Our brains are wired to produce speech like they are wired to produce walking on two legs. Should be be surprised that impulse to speak without conscious effort would be a strong one? Wendell Johnson famously said "Stuttering is what stutterers do when they try not to stutter." Ms Dahm seems to fall comfortably into the Johnson school of stuttering theory.

Let me rephrase Johnson's much-cited quotation to my own liking: "Stuttering is what stutterers do, in spite of the fact that they don't want to do it." From that perspective, we can ask new questions. When stutterers know that their speech follows a pattern of long repeats and prolongations, why do they not take control and stop? It is the longest symptoms that are felt to be the most disruptive, and most noticed by listeners/observers. One might suggest that the stutterer is hoping to get through the dysfluency sooner rather than later. In fact, stutterers themselves may say that very thing. That doesn't stop us from pointing out that after years and literally thousands of failures to get it out "sooner rather than later," that reading of the situation doesn't impress.

The stuttering literature is full of citations of stutterers - and observers - describing a "loss of control" during stuttered speech. Are both stutterers and observers wrong in their interpretation? Let's take another tack on this subject. There are just a few basic schools of stuttering speech therapy today. The mainstream methods seem to agree on their basic approach - they seek to teach the stutterer skills to consciously control his or her speech. Slow speaking, controlled breathing, relaxation.... these are all exercising control. Which, of course, Ms Dahm believes is the cause of the problem in the first place.

Both fluency shaping and stuttering modification require the client to take control of his or her speech production in a careful, conscious way. And, interestingly, those who go through both of these therapy programs sometimes find that the effort to suppress their stuttering through such active control methods grows tiring to the point that they choose to give up the effort and revert to stuttering. How can that be?

If I am right, and stutterers stutter to the degree they do because of a natural impulse to allow speech to function automatically, then both of the above observations make sense. First, it requires conscious control of speech production (as taught in speech therapy) to increase fluency. Second, the impulse to allow the natural, sub-conscious generation of speech is so great that it can overcome an otherwise successful therapy program that relies on taking the speech generation away from its natural source and assigning it to constant, conscious monitoring and modification.

So there you have it. I can't prove I'm right, but my hypothesis is in concert with the observations I've noted above. I would argue that it is superior to the Dahm/Wendell Johnson hypothesis on multiple levels. It's a start.

*** Tip 'o the hat to Jamie R. for helping me clear my thoughts on this matter. All errors, misunderstandings and general BS are mine alone.

Saturday, January 30, 2010

Silence of the Stutterers

In his book Stuttering: Science, Therapy and Practice, Thomas David Kehoe cites Marcel Wingate's definition of stuttering:

“(a) disruption in the fluency of verbal communication, which is (b) characterized by involuntary, audible or silent repetitions or prolongations in the utterance of short speech elements, namely sounds, syllables, and words of one syllable. These disruptions (c) usually occur frequently or are marked in character and (d) are not readily controllable."
(Wingate, M.E. "Recovery From Stuttering." Journal of Speech and Hearing Disorders. 29, 312-21.)

Kehoe then goes on to comment: "... a repetition is a word he can say - it's the next sound or syllable he can't produce" [my emphasis].

Not having the suttering literature at my fingertips, I cannot say how original Kehoe's statement is. I will say that I believe that it is very important. The definition of stuttering given above seems perfectly reasonable as a descriptive device. The effort is to note which phenomena are common to stuttering and which separate stuttering from other disfluencies. One might argue with the precise wording, but I think Wingate's version is reasonably representative of the definitions I have seen in my reading.

I want to note here that there is a difference between a definition of stuttering, as given above, and a definition of the nature of stuttering. Van Riper wrote a 400+ page book titled The Nature of Stuttering, and I suspect he would have said that he left out important matters to keep the size of the book down. Van Riper's effort was encyclopedic, and if anyone was qualified to attempt such an effort it was him.

Let me propose a far lesser effort, at least in scale. Rather than asking for a definition or a grand description of the nature of stuttering, let me ask this question: What is the essence of stuttering? Not the cause, proximate or ultimate; what is the primary fact of stuttering, the grain of sand around which the pearl grows?

Here, I refer to one of the celebrated public intellectuals of our time - Dr Hannibal Lecter:

Lecter: "Everything you need to find him is there in those pages."

Starling: "Then tell me how."

Lecter: "First principles, Clarice. Simplicity. Read Marcus Aurelius. Of each particular thing, ask what is it in itself? What is its nature? What does he do, this man you seek?

Starling: "He kills women."

Lecter: "NO! That is incidental."

A dramatic way of making a point, no? What is the nature of the thing, and what is incidental? Let's see if we can follow Dr Lecter's advice.

Is nervousness the essence of stuttering? No. Is fear of words that begin with the letter "b" or speaking on the telephone or speaking to authority figures? All secondary manifestations. What about the definition we began with? All stutterers share involuntary repetitions and prolongations - are they the essence of stuttering? My answer is no. Repetitions and prolongations - and probably silent blocks as well - are not the fundamental kernel of stuttering.

Repetitions and prolongations are the result of the stuttering impulse, and do not represent the essential stuttering event itself. As Kehoe noted above, the stutterer who repeats the "t" sound in the word "talk" is producing the "t" sound perfectly well, repeatedly. The failure in fluency is the inability to move from the end of the "t" sound to the beginning of the "aw" sound. The same is true of prolongations. The person who says mmmmmmmm-other is sounding the "m" sound perfectly well, but is incapable of moving on to the following vowel.

Of course, stutterers can mangle words with marvelous complexity, but Wingate's definition - followed to a reasonable degree by most in the field - shows that the most common, most recognized disfluencies exist as variations on this single failure.

So let's try to boil it down. If I am right, the essence of stuttering - the phenomenon from which all else flows - is the failure of the automatic speech processing function of the brain to generate smooth motor control from one sound to the next in certain circumstances. All the rest comes from our effort to deal with these singular failures.

Have I accounted for all observations in a consistent manner? No. What I've done is to propose a tentative, speculative hypothesis. The hypothesis assumes an organic, neurological basis for stuttering, which I believe is well-supported by the evidence. It rejects a behavioral origin for stuttering, but allows for behavioral development and environmental cues. Its value is primarily heuristic. And it allows for falsification by close examination of stuttering behavior. Good enough for a start.

Wednesday, January 27, 2010

Chasing the Fluency God

Who coined the phrase in the title above - do you know? I'd like to see how it was originally used. It seems to be one of those memes that everyone uses, but no one defines.

If you happen to find this post a year from now (1/27/10) and know the answer, don't hesitate to leave a comment - I'll get notice of it.

*** Here we have a usage from August, 1998. Let's see if we can go back in time from there:

Sunday, January 24, 2010

Nail Head, Meet Hammer

First, a shout-out to my friend Jamie Rocchio for providing a great topic to discuss. Jamie is a regular guest on the podcasts, and on Episode 172, a little less than half-way through, she raised one of those questions that cuts through the BS and gets right to a critical point regarding stuttering therapy:

“If it’s OK to stutter, then why do I have to change?”

You are welcome to go listen to the podcast and hear both the context of Jamie’s question, and the discussion that ensued. Here, I’m going to take the question as my own and see what I can do with it.

An Internet search of the words “OK to stutter” comes up with a limited number of hits, most using the admonition as advice to children. Such advice can be understood as a reasonable effort to remove the stigma and fear of stuttering from children. In this case, “it’s OK” means that it is not a crisis or a disaster. This is a neutral statement: “It is all right/it is not bad/we will not be angry if you do it.” Giving the stuttering child permission to stutter (which he or she will inevitably do) without self-imposed penalty can only aid in lowering anxiety levels regarding speech performance.

There is, however, another variation on the “OK to stutter” meme. In this case, the statement is a positive one. We could phrase it variously “There’s nothing wrong with stuttering” or “there’s no reason why you should try to stop yourself from stuttering” or even “stuttering is just another way of speaking.” Here, the words are my own, but I’m trying to reflect a “stutter-positive” attitude that is not difficult to find in the stuttering community. As I understood Jamie’s statement quoted above, this is what I heard he to be referring to. The advocacy of open stuttering and voluntary stuttering could hardly exist without my paraphrasing above being reasonably accurate.

This stutter-positive message can easily be supported by reasonable, rational argument. There is, in fact, no reason for stutterers to feel shame or guilt or fear. Those are all self-imposed punishments, and can be removed with reflection and self-examination. While stuttered speech is sub-optimal, it is capable of containing the same information content as speech in the normal/fluent range. Some listeners will respond negatively, but we are all capable of understanding that fact and taking it into account. With sufficient equanimity, we can humor the less-than-sympathetic listener and pity those who are hostile.

Given the above, and given that such stutter-positive messages come from speech therapists as part of their understanding of the nature of stuttering and the condition of the stutterer in society, I could reword my friend Jamie’s question above to direct it towards the speech therapist thusly: If stuttering is OK, then what am I paying you for? If the therapist - as opposed to the stutterer - believes that stuttering is OK in a positive sense, then the need for speech therapy, as opposed to psycho-therapy - goes out the window.

In order to deal with the baggage of years of stuttered speech, a person needs to shed the negativity that has encrusted them like barnacles on a ship’s hull. The fact that those negative feelings can be reinforced every time we speak means that we have to both give up the memory of old fears and stop the generation of new ones. If we understand our stuttering as sub-optimal speech performance rather than a moral or personal failure, then we can be free to engage in speech therapy (speech performance improvement) without the negative secondary feedback of performance anxiety. If, on the other hand, we take literally the admonition that stuttering is OK - as in there’s no reason we should wish to not do it - then this reasonable, rational admonition does raise what we might call the happy-stuttering speech therapist’s dilemma: If I really believe this, why don’t I just send them to a psychologist to deal with their negative emotions and let them stutter in peace?

This is the question I understood Jamie to be asking on the Stuttertalk podcast, and the question never did get answered. We can imagine an answer that squares the happy-stuttering circle, but it requires one say “When I say it’s OK to stutter, I don’t mean….” This is a complex subject, and simple admonitions don’t lend themselves to subtle distinctions. The problem is two-fold. Sometimes, we hold conflicting positions that lead us into logical dilemmas when examined (stuttering is OK: there is value in speech improvement therapy). On the other hand, our way out of the dilemma may be to accept that we really don’t mean what we say.

Note: All interpretations of statements made on the Stuttertalk podcast are my own. I have taken a quote from the podcast for my own purposes. To hear Jamie and Eric discuss the topic in their own words, please go here:


Monday, January 18, 2010

The Pill Question

It seems to be popular in the stuttering community to ask the question "If there was a pill that cured stuttering, would you take it." Sometimes, I imagine it's used simply as a conversation starter among stutterers shy about talking. I have the sneaking suspicion that it may also be used by speech therapists in a counter-intuitive manner to suggest to stutterers that they should see positive sides to their stuttering.

Since the question seems to be a bit of a cliche now, I'd like to rephrase it to start a new discussion, and make a different point.

If there was a pill that caused life-long, incurable stuttering, do you think that non-stutterers would take it?

Ahhh... that's different, isn't it? Compare and contrast the two questions.

Thursday, January 14, 2010

Killed By An Ugly Fact

[Addendum: I've just found a very interesting blog by Silvano Columbano that collects entries from the STUTT-L list during the 1990s. I'll add a link to the blog, but specifically relevant to the topic of this entry is this post.]

One of the basic tests of a scientific theory is whether it explains observations of the subject of interest. Or, turning that around, is there anything we know about the subject that conflicts with the theory? There’s a famous saying in science regarding a beautiful theory being killed by an ugly fact. It appears from a casual reading in the world of stuttering that those who propose theories are not constrained by such unfortunate facts.

Barbara Dahm is a well-known name in speech therapy, and .is the founder and Director of CTI Communication Therapy Institute. After working as a speech therapist for many years, she developed her own therapy program: Generating Fluent Speech: A Comprehensive Speech Processing Approach.

In a short article reprinted in the book Stuttering: Science, Therapy and Practice, Ms Dahm describes here education, from graduate school through the study of Gestalt psychology, to training in the Precision Fluency Shaping Program. Finally, after working with clients and feeling unsatisfied with fluency shaping, she developed her own Comprehensive Speech Processing Therapy (yes, these programs are apparently all worthy of capitalization).

Ms Dahm‘s therapy program is based on an insight she had when working with stutterers. She states: “My firm belief is that people stutter when they are exercising control over speech processes that are meant to function on an automatic mode.” Hmmm…. let’s think about that. She doesn’t say that some people stutter, or people stutter some times; she makes a general statement that stuttering occurs when there is active control over the speech effort, rather than the natural, un-self-conscious process present in non-stutterers. This brings to mind the classic parable of the centipede, who loses his ability to walk when he stops and thinks about the necessary coordination and movement of all his one hundred legs.

In order to make sure I’m not taking the above quote out of context, lets look at another:

During the Generating Fluent Speech program, people who stutter relearn the speech production process. While doing the various exercises, they learn to vibrate their vocal folds in an easy effortless manner that eliminates the feeling that they do not have enough air to speak. They learn that it is not only not necessary, but, actually, debilitating to monitor words and speech sounds. The Generating Fluent Speech exercises help them to move their focus of attention away from this activity. As a result their language development process is simplified and becomes subconscious. In addition, they learn to give up control of their speech muscles. Articulation becomes an automatic process that works efficiently at a rapid rate.” (My emphasis added).

I think it’s fair to take from the above quotes the assumption that it is the attempt to consciously monitor and control the speaking process that causes stuttering behavior. Like the poor centipede who tries to consciously coordinate all one hundred legs and becomes paralyzed by the complexity, so the stutterer tries and fails to monitor and consciously control the highly complex process of speech production.

Assuming I’ve been fair in interpreting the above quotes, let’s stop and think about this. At the beginning of this article, I said that one of the basic tests of a scientific theory is whether it explains observations. Here, the claim is that stuttering occurs when the speaker is “exercising control over speech processes that are meant to function on an automatic mode.” Are there any observations that conflict with this assertion?

Ask yourself, does stuttering only occur when the speaker has had an opportunity to assert conscious control over his or her speech? Or turn the question around and ask “Does stuttering behavior ever occur when there has been no opportunity for conscious control of the speech process?” More simply, does stuttering ever occur without warning? To me, the question is rhetorical - because the answer is so obvious.

With the exception of the most extreme cases, stuttering is defined by its episodic occurrence Although there are situations in which stuttering behavior can be expected - and might fit the theory, at least in part - most stutterers encounter blocking without warning as well. We can stutter when we are with family, when we are relaxing, or in the middle of an otherwise fluent sentence. Any observation of stuttering behavior over time would reveal many such examples. Self-consciousness may aggravate stuttering frequency or severity, but self-consciousness is not synonymous with conscious control of the speaking process.

We can look at this question from another angle. If the hijacking of the automatic speech process by conscious effort produces stuttering, then shouldn’t we expect people who are asked to speak with conscious control to stutter? Does an actor stutter when learning his or her lines? In fact, stutterers have been known to gain total fluency by speaking with a special accent. For the average American, much less and American stutterer, speaking with a fake accent would surely require constant monitoring and control. How does Ms Dahn’s theory of stuttering explain this observation?

When children are asked to read aloud in class, they are in a situation that restrains natural speech and requires much more control than conversational speaking. Does reading aloud in school produce stuttering? I am not familiar with the scientific literature, but I have never heard such an assertion.

We are left with observations of stuttering that conflict directly with the theory proposed by Ms Dahm. I am confident that the disparities between theory and observation are so great that the theory must be rejected. So what does that say about Ms Dahm’s work in stuttering therapy? Perhaps, not much. Perhaps she is successful as she claims to be. How do we explain this?

It could be that her therapeutic methods work - when they do - for reasons divorced from her understanding of the justification for them. You might say that she is doing something right for the wrong reason. In the end, her correct methods work in spite of her theoretical understanding, not because of it. Another possibility is that her success comes less from her method than from a generalized therapeutic effect. That is, all that work on speech and support from instructors makes the client feel like they are doing something valuable, and so they gain benefit. This would help explain why different therapy programs, with very different theoretical underpinnings, report similar success rates. It may be that it’s less important what you do than that fact that you’re doing something.

The point of the article is to show that a person who has worked professionally for decades, and has developed their own stuttering therapy method, can miss an observation that has been staring them in the face for years. Conscious effort does not cause stuttering - stuttering causes conscious effort, which may aggravate stuttering frequency and severity. To understand the causes of stuttering, and to provide the best possible therapy, at a minimum you have to get the direction of cause and effect correct. Pain and a limp do not cause a ruptured disk in the back, and conscious speaking effort does not cause stuttering.


Generating Fluent Speech: A Comprehensive Speech Processing Approach

Stuttering: Science, Therapy and Practice
, by Thomas David Kehoe.

Monday, January 11, 2010

Stuttering As Hunt-And-Peck Speech

Thomas David Kehoe is the author of the book Stuttering: Science, Therapy and Practice, subtitled The Most Complete Book About Stuttering. The book runs over 300 pages, and covers research, therapy and practical advice for stutterers. The book provides both an overview of stuttering topics and Kehoe’s commentary and personal beliefs. I’d like to comment on one particular point that the author makes, based on his own understanding of the nature of stuttering.

In the chapter Motor Learning Theory, Kehoe makes a distinction between bad habits and maladaptive motor skills. He does this through an analogy with typing. Kehoe is a four-finger typist, which limits his typing speed, but to significantly improve his speed, he would have to learn touch typing properly from the beginning, and temporarily type very slowly while learning proper technique. He goes on “Stutterers can talk, but not as well as they could if they had learned to speak fluently when they were children.” Later in the book, he says .“Stutterers can talk, but not as well as they could if they had learned to speak fluently when they were children.”

This is where my head explodes. We learn to stutter analogously to the way we learn typing? It boggles the mind. Is there something about stuttering that fogs people’s minds? And this from a stutterer.

Where do I start? Stuttering is not a maladaptive, suboptimal motor skill. To the degree that stuttering requires a particular set of motor skills, those skills are insignificant byproducts of the stuttering impulse. Stuttering is not a motor skill, it is the intermittent loss of normal speech motor skill.

As children, stutterers certainly learn maladaptive behaviors. Stutterers learn to increase tension in their speech muscles, to fidget and to lose eye contact. Those behaviors are not part of normal speaking, subtract from normal communication, and feed back to increase stuttering severity. They are not, however, essential parts of the primary stuttering impulse or behavior. Those secondary elements of stuttering can be stripped away entirely, but the primary stuttering impulse and behavior will remain - which is just an observation of the notorious persistence of stuttering.

Four-finger typing is sub-optimal because it does not take advantage of all available fingers, as intended by the keyboard. It is not sub-optimal because sudden cramps in the hands cause four rather than eight fingers to be used. Any hunt-and-peck typist can learn to touch type with sufficient effort. Would that it was so for stutterers. Human children are wired to learn speech, without conscious teaching or effort - it comes naturally, like songs in birds. Stutterers are not people who fell into poor technique as children. Stutterers encounter interruption of proper technique, recognize the failure of their natural speech, and respond the only ways they can - sometimes maladaptively - as children.

Typists can be taught a new method of typing by simply dropping the old method entirely and replacing it with a new one. The maladaptive behaviors of stuttering can be pointed out and removed from a stutterers’ speech - with great effort - but replacement of all stuttering with fluent, natural speech is another matter entirely. Unlike typing, stuttering comes with the impulse to stutter, which is notoriously resistant to suppression by simple motor practice. The neurological impulse, which was never part of the behavior, is not dealt with directly by speech practice.

Speech therapy can certainly decrease stuttering disfluency in many people, typically by slowing down and otherwise altering speech to the point that it is volitional - and disfluent, in a controlled way, by rate, rather than in an uncontrolled way by interruption and repetition. Kehoe claims that fluency can, in fact, be reached and retained by such practice, but then says that most stutterers just won't stuck with the process long enough to be successful. I would suggest that his misunderstanding of the nature of stuttering is a better explanation for the lack of truly fluent, natural speech success stories than his behavioral model of stuttering.

The more I read, the more I wonder: is there something about stuttering that causes fuzzy thinking?

I'll add that this is not a book review, and the book has plenty of good information in it. This one analogy - which Kehoe uses to justify his therapy beliefs, just stuck out like a sore thumb. Or typing finger.

Saturday, January 9, 2010

Easy For You To Say

Many years ago - perhaps around 1980 - I read an article or a book about stuttering that contained a claim that stayed with me for some reason. It wasn’t particularly noteworthy to me at the time, but it buried into my memory and stayed available until now. The writer proposed a problem in the stuttering community. I don’t recall his exact words, but to paraphrase, he said that there was a problem with mild stutterers giving advice to more severe stutterers.

Here, I’ll describe the problem he saw (as I remember it), and comment and elaborate on it as I go along. He described a situation in which people with a relatively mild case of stuttering set up a local self-help group. It takes a certain amount of confidence to do so, so we shouldn’t be surprised that a person who has a relatively mild stutter would be the one to do so. Notices go up, maybe a listing in the local newspaper, and a few brave stutterers show up for the first meeting.

As the founder of the group, and already having a reasonable degree of fluency, our mild stutterer becomes the leader of the group. We can imagine that other members with a more severe condition might hang back, happy to be in the group, but still not willing to do a lot of talking.

So time goes by, they meet each month, and gradually the leader - and any other mild stutterer in the group - start to get confident in their speech in front of the group. After all, in the land of severe stutterers, they actually become the (relatively) fluent ones. The group gives them practice speaking in front of an audience, and to get long pent-up frustrations off their chest. For these mild stutterers, the group is truly therapeutic.

Time passes, the mild stutterers keep benefiting, while the more severe stutterers gain a sense of community, but little else. It’s nice to make friends and share stories with other stutterers, but they still tend to hang back and let the more fluent do much of the talking. Their speech in front of the group changes little, and any benefit goes away when they leave the meeting room.

Finally, the leader and the other mild stutterers decide that they’ve derived all the benefit they can from the group, so they decide to leave it and use their new-found confidence in their every-day lives. Which leaves the more severe stutterers to themselves. Now, with the more fluent and talkative stutterers gone, no one picks up the leadership, the group becomes less positive and affirming, and it gradually breaks up.

So those whose speech could be expected to benefit the most have harvested the benefit and moved on, and those most in need have been left behind with little to show. Unfortunately, I can’t cite the author of the above, much-paraphrased story, but that was the gist of it as I remember. If it sounds familiar to anyone, I’d love to hear from you.

I can’t vouch for the validity of the story, but it certainly made sense me, enough to remember it after all these years. It’s hard to imagine anyone making it up, so let’s go with it and assume it has some factual basis. I think it’s reasonable to say that in any self-help, self-improvement group, there’s a point where people feel like they’ve gotten all the benefit from the group they can, and they move on. In this case, we have a situation in which one group - the mild stutterers - are capable of improvement to the degree that they no longer feel the need for therapy of any kind. They were relatively (to severe stutterers) fluent already, and by simply adding experience with public speaking and a degree of confidence they become ready to face the world. The other group - the more severe and persistent stutterers - began far from fluent, and any benefits they could gain from the group meetings leave them still far from confident and far from fluent. And disappointed at being “left behind.”

This brings up back to the dynamics of the group itself. It’s natural in such a group for members to share experiences and problems and advice. If it was a writer’s group, we could imagine the sharing of methods to get past writer’s block. For stutterers, it would be natural to talk about how each member understands the nature of stuttering - nature of nurture, perhaps - and to discuss any methods they’ve used to gain more fluency.

Here, we run into the original problem posed by the author. Who is more likely to consider themselves a role model for relatively severe stutterers than another stutterer with greater fluency? Even a stutterer with little disfluency can be expected to remember severe blocks and terrible anxiety during their younger years. When severe stutterers discuss their frustration and pain, it can all be perfectly familiar to the now-mild stutterer. So why shouldn’t such a person want to help a fellow sufferer and pass on advice to them?

The question this brings up in my mind is, to what degree are the experiences of the mild, improving stutterer and the severe, persistent stutterer the same? They obviously differ quantitatively, in terms of blocks per 100 words, or repeats per word. Might the conditions also differ in quality? Is it sufficient to speak of mild and severe stutterers as simply variations along a continuum, or is the degree of difference so great that some fundamental differences are lost by thinking in terms of degree? And if we do see a fundamental difference between mild and severe stutterers, should severe stutterers be listening to mild stutterers for advice?

The problem of the mild stutterer giving advice to the severe stutterer was proposed in a general sense by the author whose article I read those many years ago. I assume he was referring to personal experience in self-help groups, but let’s take the principle and see if we can generalize it in another direction.

Since at least Van Riper, speech therapy has attracted stutterers to the field. What could be more reasonable than victims of the condition wanting to help others who share their experience? And indeed, it seems as if there are many stuttering speech therapists out there today, both senior practitioners and newly graduating students. If so, we could apply the implications of my earlier speculation and ask: could speech pathologists who stutter be relying on their own experiences and mis-applying them to the cases of stutterers whose conditions are quite different from their own?

Time to take a step back. What is the case for stutterers working as speech pathologists? One can imagine a parent asking a speech pathologist “If you stutter, how can you help my child?” ”Physician, heal thyself” comes to mind. Of course, our stuttering speech pathologist has the obvious retort: “Who knows better than a stutterer the experience and the needs of a stutterer?” Quite so! A non-stuttering speech pathologist can learn the best practice for therapy, and can be full of empathy, but he or she can never know the experience of stuttering on a subjective level. The testimony of stutterers can communicate the facts, but cannot pass on the visceral experience of stuttering.

So here is the benefit of the stuttering speech pathologist. But if we go back to the content of the previous paragraph, we can probe further and ask: if stuttering speech pathologists are using their subjective experience when seeking to understand the condition and working with clients - and it’s hard to imagine them not doing so - then if their condition actually differs in some important, qualitative way from some stutterers (less, as opposed to more severe, perhaps), then could their own subjective experience be causing them to misunderstand the condition in a particular client?

The non-stuttering therapist lacks the subjective knowledge of stuttering. They may simply not get it. Then again, they also lack the stutterer’s confidence that they understand the phenomenon on a personal level. Thus, they can’t suffer from incorrectly generalizing their own subjective experience to their clients. In the best case, a non-stuttering therapist would come to the condition with an open mind, and remain open to new evidence and analysis.

So let’s go back to the beginning, and ask some questions. Does it make sense that mild and severe stuttering could be qualitatively different in such a way that stutterers from opposite ends of the continuous spectrum are significantly different in some way(s)? It is possible that those hypothetical differences could cause stutterers to mistakenly generalize their own experiences to others? And if so, could the advice - or even simply self-reporting - given by mild stutterers, in either self-help groups or in clinical practice, be doing a dis-service to more severe stutterers?

I dunno - I’m just asking.

Sunday, January 3, 2010

Does Stuttering Attract the Best Minds?

Being safely free of any evidence in this matter, I feel free to ask the question. This is an issue I’ve been wondering about for a long time. Stuttering comes with multiple burdens for the success-oriented student looking for a field to enter. The condition is notorious for its persistence, and few people wants to spend their lives fighting losing battles, or gaining small successes at best. Young researchers are taught to choose topics that lend themselves to successful study results, and, most importantly, paper publication. And in science and medicine, everyone follows the money. Stuttering neither kills nor shortens one’s lifespan. There are no purple-for-stuttering ribbons, and there are no Walks Against Stuttering or telethons to raise private funds for research or treatment.

It is easy to understand how a lack or resources would restrict the ability of researchers to make breakthroughs. The disincentive to enter the field in the first place is a more subtle matter. Some fields loose their attraction after they’ve matured and the Big Problems of the past have been largely solved. Others never attract the best minds because no one seems to make their name in them. Funding agencies look for the best bang for their bucks, constantly looking for the next big breakthrough, and researchers follow the money

We could ask whether the inherent difficulty of the stuttering problem itself is sufficient to explain the lack of advancement in the field, or whether a lack of resources is to blame. Phrased in another way: is stuttering really more difficult to study successfully than other subjects, or is it just a lesser priority than other, equally difficult subjects?

The truth is that not all fields and sub-fields of science attract the same quality thinkers and workers. A comparison of GRE scores (graduate school entrance exams) would reveal a range of averages, with the highly mathematical fields at one end, and the less rigorous, “soft” fields at the other. And within a broad field, the best, most ambitious researchers, professors, post-doctoral researchers and graduate students will gravitate towards work that produces regular, if incremental success, scientific publications in prestigious journals, and professional advancement. Research topics that do not provide such possibilities can become orphan fields, with little money, advance or prestige available. This does not mean that no work gets done - it simply leads to pedestrian research and i-dotting and t-crossing-results rather than dramatic breakthroughs.

One could ask the same question regarding speech therapy. Every therapeutic failure of the past has had its advocates, and many have been licensed professionals and graduates of, no doubt, the best speech pathology programs. I’ve seen multiple discussions of evidence-based speech therapy, but are researchers and therapists properly trained to examine the evidence? The truth of medical research is that many published studies are garbage, plain and simple. They follow the form of the scientific method at a surface level, but they lack the rigor needed to truly answer the question raised. Are speech therapists sufficiently prepared in experimental design and analysis to make sense of the literature of their field? In the same way, we can ask whether they are prepared to analyze their own clinical experiences in a rigorous way. Rigorous critical thinking does not come naturally; it needs to be learned by example and by practice. It is cruel; constantly searching for flaws and questioning assumptions. Does speech pathology education produce such thinkers, or does it produce (hopefully empathetic) speech firemen/women, too busy putting out clinical fires to challenge their own training?

One question has evolved into multiple questions. And all of the latter questions refer us back to the former. What would happen if the best minds in computer science, medicine and physics turned their attention to stuttering? What if the world’s top neurologists and brain researchers took on this topic as their life’s work? And what if Bill Gates dropped one hundred million dollars on funding university chairs, laboratories and clinical researchers dedicated to stuttering? Would it matter, or is the money and effort best used elsewhere? I don’t know, but I suspect that the field could desperately use the kind of brain-power such an effort would bring. No offence to current practitioners, buy the difference between very good and great can be the difference between failure and success.

After Francis Crick teamed with James Watson to discover the structure of DNA during the 1950s, he went on to team with others and perform a series of experiments to determine the genetic code. Molecular biologists still teach from the resulting journal papers, and describe the work as elegant and beautiful. Who today is doing elegant studies of stuttering? Whose work is so tightly constructed that it can rule out all competing hypothesis? It would be wonderful to learn that they are already out there in a lab somewhere. Maybe they are.

A New Year, a New Blog

One more time, I take advantage of Google's generosity to create a new blog. Or rather, use their free blog offer to create a new web site. This will be less a blog than a place to publish my thoughts on stuttering as they occur to me. My only qualifications are that I'm a life-long stutterer, and I've got a bad attitude. Which will mean, more often than not, that I'll be using this opportunity to challenge what I find elsewhere, whether it's in books or on the internets.

So feel free to comment and criticize - I welcome people who make me think, and I'm not thin-skinned.