Monday, November 28, 2011

Stutterers Who Stutter

I'd like to take aim at the 'person who stutters' business in this entry. For those who don't know, an assertion has been made that 'person who stutters' is preferable usage to 'stutterer.' As a person who demands accurate language (or is simply a language fuss-budget) this dispute is right up my alley.

There are a few facts I'd like to establish regarding 'people-first' language. First, it came from outside of the stuttering community. On the web site of the American Speech-Language-Hearing Association, they justify person-first language with references to the National Easter Seals Society and the National Rehabilitation Association. I think that it is highly likely that these two organizations had no input from stutterers when they created their own guidelines.

So the people-first preference originated in groups concerned with other disabilities. But isn't the principle the same for all disabilities? This leads to our second fact. In both the deaf and the blind communities, people-first language has been rejected. That is, a sufficient number of blind and deaf people spoke out against people-first constructions to knock it down in their fields. (see Wikipedia).

Which leads me to ask, how did people-first language gain ascendancy in the world of stuttering? A little thought on the subject leads me to speculate thusly. People-first language took hold in the professional speech pathology field because the advocacy for it focused, successfully on a top-down adoption, and because there was no grass-roots stuttering 'community' to raise their own voice to reject it.

To elaborate on the lack of reaction to the people-first movement by stutterers, I'll point out that in the Boston, Massachusetts area where I live, there are two National Stuttering Association support groups. For the chapter that meets nearest to me, a very rough estimate of the population it serves would be the Census Bureau's Boston-Quincy MA Metropolitan division, which has a population of over 1,800,000. Which, given the 1% estimate of stuttering incidence, would give us 18,000 stutterers. At the meetings I've been to, we've had between two and five stutterers attend. So much for a 'stuttering community.' The fact is that stutterers, unlike the deaf or blind, seem to naturally avoid each other at all costs.

Given the lack of sociability or unity in this community (to the degree that we can call stutterers a community at all), I think we can rule out the change to people-first language out of any 'bottom-up' effort by stutterers to choose how they are defined. This virtually universal change in a perfectly well understood (and neutral) term came from the top down, for our own good.

So why did they do it? Why did the ASLHA decide in 1992 to tell workers in the field to change their language? Here I recommend you read the ASLHA web pageon the topic. I'll respond to each of their 'principles' here.

First, they instruct - not suggest - that person-first language be used, citing the two documents I referred to above.

Specifically, they say "Disabilities are not persons and they do not define persons, so do not replace person-nouns with disability-nouns." What we have here is a failure of logic. Researchers and clinicians do not discuss 'people who stutter' in their roles as family members or employees or artists or citizens. Speech pathology professionals discuss 'people who stutter' BECAUSE THEY STUTTER. If a speech professional is writing about my speech pathology, I expect them to focus on the pathology, and not my love of fishing, or my role as a son and brother.

The second principle, disability versus handicap, is not relevant to the person-first issue.

The third principle is only tangentially related to 'person-first,' but I can't resist giving it a kick. This principle proscribes the use of the normal/abnormal dichotomy. Here we are told to replace 'normal speakers' with 'individuals who were judged to show no speech, language, or hearing impairment.' Good God! Here, we have a failure of clear thinking and writing on a major scale. Speech pathology exists because some people speak abnormally. The normal/abnormal dichotomy has not been used by the speech pathology profession to define those who stutter as 'abnormals.' To suggest otherwise would be quite an indictment against the profession.

The fact is that speech is a normal human process. Our bodies are designed to produce speech in a near-effortless manner. Some of us suffer from a pathology of speech - we stutter. There are people who speak normally, and there are people whose speech is interrupted by abnormal efforts and output. Stutterers speak abnormally. That's why we go to speech language pathologists and pay them money. That's why Ph.D. researchers are given grant money from the government. To deny that some people speak normally and some don't is to be perverse. That the professional association that works with stuttering seeks to deny the plain facts of the condition - its abnormality - is mind-boggling.

The fourth principle advises to "avoid terms that project an unnecessary negative connotation. For some reason, a majority of the language they proscribe does not refer to speech, so why they include it here is a mystery. Their comments on 'courageous' and 'unfortunate' are reasonable, but get lost in the rat-bag of terms they include.

Their final principle is an interesting one. "Don't overdo it," they recommend. I would suggest that given their first four principles, they need to do some thinking of their own.

To sum up: I am not a fan of 'person first' language. I think it results in euphemisms that don't make distinctions of value. We are not dealing with terms like 'retard' or 'cripple' here. In our case, the difference between 'stutterer' and 'person who stutters' is in the mind of a small number of people, and trivial at best. It was adopted by speech language professional organizations out of either a fear of offending (at best) or a 'cover your ass' mentality (if we go along with it, no one will be able to accuse us of being 'insensitive'). My main objection to the adoption of person-first language in the stuttering field is that no one asked me for my opinion, and the adoption of person-first gives someone, somewhere veto power over both writers in the field and over stutterers like me. Did it occur to anyone at the American Speech-Language-Hearing Association that some of us might be offended by person-first language? Apparently not. As happens so often in these matters, the squeaky wheel got oiled.

There are times when 'person who stutters' or 'those who stutter' fits a sentence. I use the form myself - when it is appropriate. I am offended when my 'sensitivities' are shielded by far-off professionals, as if I was some kind of hot-house flower, and they the father-protector of my fragile psyche. And I am offended by bad writing and euphemistic jargon. I am a stutterer. And a local history expert. And a vegetable gardener. And an opinionated blogger. I don't need an alphabet-soup organization protecting me from the fact of my own half-century old speech pathology. Deaf people boast of their identity. Stutterers don't need to help of speech language professionals to run away from ours.

Note: for another rant against 'people-first,' read this.

Tuesday, November 22, 2011

You are fluent (really!)

Is English your native language? If so, then no doubt you are fluent - in English. Wasn't that easy? If you doubt that you are fluent, ask a friend - or a stranger - to use the word 'fluent' in a sentence. The result will be something like "He is fluent in English," or "She is fluent in French." Then ask that person what the word fluent means. The answer is guaranteed to be something along the lines of "has mastery of the language" or "speaks and understands the language."

Given that this word has a perfectly clear meaning to all English speakers, how did it get a different meaning in the world of stuttering? Marcel Wingate notes in one of his books on stuttering that when he looked up the related word 'disfluency' in dictionaries, it wasn't there. The only dictionary he could find 'disfluency' in was a medical dictionary, and that book took the meaning from the stuttering literature, not from general usage.

In this matter, there is, as they say, more than meets the eye. The word fluency became synonymous with 'normal speech' in order to get the previously non-word 'disfluency' into the language of speech pathology. Here, we need to know some history of the field of speech pathology, and stuttering research in particular.

In the early part of the 20th Century, there were different theories on the cause and nature of stuttering. Starting in the 1930s, when the field started becoming professionalized, and students began receiving Ph.Ds in the field, the most important and influential theory was probably that of Wendell Johnson, who asserted that stuttering was a learned behavior. Johnson believed that stuttering grew out of the normal errors of children's speech. It was the parents and teachers mistaken idea that the child actually had something wrong with his or her speech that caused the child to internalize the belief. This lead the child into maladaptive speech behaviors, which then became ingrained over time.

This caused Johnson to see stuttering as just one end of the speech error continuum. On one end was the blocks and prolongations of stuttering. On the other was the set of hesitations, repeats, in interjections of everyday normal speech. All of these errors of speech, stuttered and non-stuttered, belonged in a single category. And that category was 'disfluency.'

As a result, volumes of speech and language journals have been filled with studies by academics, counting and categorizing 'stuttering disfluencies' and 'normal disfluencies.' A regular claim of experts is that one cannot separate stuttering from non-stuttering because each single 'disfluency' cannot be confidently ascribed to either 'stuttering disfluency' or 'normal disfluency.'

This is what is called 'paralysis by analysis,' in which experts paint themselves into a corner and then define the floor as unpaintable. Of course, the truth is that you can take any ten people off the street, and they will tell you whether an individual is stuttering or not with great reliability. The wisdom of the common man - and the folly of the experts - is that the common man doesn't concern himself with the categorization of each and every imperfection of speech. One could say that they don't know that meaning of 'disfluency,' and that's a good thing.

The truth is that the words fluent and disfluent do not elucidate the condition of stuttering - they obscure it. A perfectly good word (fluent) has been hijacked to serve an idea that has been shown to be incorrect year ago. In spite of that fact, the twin terms (fluency/disfluency) remain, and continue to shape though on the subject.

Those who stutter do not need to become fluent. Statterers are fluent - in their native language. So if stuttering isn't disfluency, what is it? Answer: stuttering is a pathological condition that results in abnormal speech production. Speech produced by people who do not stutter is normal speech, with all its momentary errors and flaws. Think about this: how can a fluent speaker produce so-called 'normal disfluencies?' If your speech is fluent, how can it be disfluent at the same time?

As far as stuttering is concerned, there are two kinds of speech: the flaws produced during a stuttering event, and everything else. Stuttering and non-stuttering, not disfluent and fluent. Every person who stutters produces mostly normal speech. The abnormal speech - the repeats, the prolongations, and the inability to begin speech at all - these are the symptoms of the condition.

Why does this matter? It matters because the focus is removed from every little error and imperfection of speech, and applied directly to the real problem. There are classes for public speaking, where people seek to break bad habits like interjection 'ah,' 'umm' and 'like' into their speech. Those people do not go to a speech pathologist. These speech behaviors actually are learned behaviors (unlike stuttering), and it is trivial to correct them. All it requires is attention and practice. And once removed, they stay removed.

When we stop thinking in terms of disfluency and fluency, we are left with what separates us from non-stutterers. We have a condition that somehow interferes with the normal speech production process. Unlike the normal speaker in a public speaking class, our flaws are not simply learned behaviors, and preventing or changing them is not a trivial matter. When we shift from thinking in terms of fluency to normalcy (with it's regular and largely unnoticed imperfections) we stop worrying about perfection. Normal speakers speak imperfectly all the time - and they are normal! And when we stop thinking in terms of disfluency (the rat-bag term for any and every imperfection of speech, whether it has anything to do with stuttering or not) we are left focusing on the core or stuttering, the block, and the maladaptive things we do to get out of a block.

Take-home message: you don't need to become fluent, you are fluent. Stutterers are not disfluent. Stutterers suffer from a speech pathology, a condition that causes interruptions (blocks) during the production of words. The generic name for what results when a person with this condition experiences a speech block (repeats, prolongations, etc.) is stuttering. Not disfluency. Non-stutterers don't go to their doctor complaining of disfluency. There are no professional speech pathologists treating clients for pausing and interjecting 'you know' into sentences inappropriately. What stutterers should seek is not fluency, but less interruptions by stutter blocks and the resulting maladaptive mess we make of ourselves, and more 'normal' speech. That's normal in all it's imperfect glory.

Note: please don't fear normal/abnormal. Cancer is the abnormal growth of cells and tissues in the body. Diabetes is the abnormal regulation of blood sugar. Abnormal is not a value judgement. Normal is what comes out when the system is functioning properly. Let's not be in denial and pretend that what we do is not abnormal. The very last thing stutterers need as a group is more denial.