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.

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