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