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.