Monday, January 9, 2012

A Proper Name: Part I

In the previous entry, I made an argument for the use of stutter rather than stuttering as a name for the condition. By using a noun, we communicate that this speech disorder is the result of an underlying condition, and is not simply a learned behavior, as stuttering, a verb, implies. Stuttering, then, is what a person with stutter does. Thus, when using the term stutter in this way (he has stutter) we tell the listener that the speaker is not just talking funny; he/she has a condition that causes their speech to be disordered in this particular way.

I allowed in the previous entry that the relatively new term persistent developmental stuttering has its place, though preferably as persistent developmental stutter. However, while the two modifiers do serve a valuable purpose in making a distinction among the different types of stutter (non-persistent and non-developmental), I am still not satisfied with even this more technical name.

Persistent developmental stutter works because when we see the word stutter, we know to what is being referred. In that sense, the name works perfectly well. However, while the two qualifiers (persistent, developmental) distinguish the life-long condition that develops in childhood from the passing childhood and neurogenic (injury-induced) versions, there is still a problem with the base name - stutter.

While the terms persistent and developmental were applied to serve the need of the speech pathology community for specificity and clarity, they retained the base name stutter. This word, of course, is onomatopoeic, coming from they stereotypical phonetic repeats that are common to the condition, and is typical of names used for the condition in many languages. It is not, however, a scientific name, and does not, as is the case with persistent and developmental, specify anything. It is simply an agreed upon label that points to the condition if one already knows what stutter is.

I'd like to suggest that what is needed is another, more precise term for the condition. We need a name that specifies in itself exactly what is being referred to, in rigorous language. Just as there is value in separating out persistent developmental stutter from non-persistent developmental stutter and neurogenic stutter, there is at least as much (if not more) value in specifying in a name exactly what the condition, whether persistent or not, is by nature.

So what does it take to provide a concise name that is necessary and sufficient to define what the condition commonly known as stuttering actually is? Many definitions of the condition include the phrase 'is characterized by' (as in 'stuttering is characterized by repeats and prolongations'). This may be so, but it does not tell us what the condition 'is.' To do so, we have to go beyond what the naive observer sees, the so-called stuttering, and tease out the essence of the disorder. The fact that the field of speech pathology considers this effort so rarely is remarkable to me in the extreme.

As I have pointed out elsewhere, discussion of 'disfluency' only serves to obscure understanding of the condition. The disorder of speech observed in stutter is the result of a pathology of the speech process, and is specific to that pathology. Stutter is not just a speech disorder; it is a unique speech disorder. In spite of decades of effort on the part of researchers to deny it or obscure it, the simple fact is that stutterers stutter, and no one else does. There is no scale of disfluency on which stuttered speech can be located.

If the above sounds like strong language, the reader is invited to explore the literature of this field. Entire books are written on the topic of stutter without ever locating rigorously what has been called the 'moment of stutter.' In fact, again and again, you will find leading names in the profession describe stutter as 'repeats of phrases, words, syllables or part words.' This is so common that quoting a particular 'expert' would be unfair (Woody Starkweather, hint hint).

In fact, there is nothing in the repeating of phrases or words that is unique to stutter. Nothing. And in fact, repeating of whole words (much less phrases) is only trivially connected to the fundamental pathology of stutter. Such verbal behavior is analogous to the person who hold his hand to his jaw when he has a toothache. One follows on the other, but the core fact of a toothache is not that one holds one hand to one's jaw to deal with the pain. The essential fact of toothache is tooth decay, a particular biological process that results in the stimulation of a nerve.

Just as a toothache has an essential fact, so does the speech pathology of stutter. There is the essence of the pathology, and there is 'the rest.' While the profession of speech pathology (I'm thinking of research and theory here) has long been obsessed with 'the rest,' I am focused here on the core of the condition, and will allow other to concern themselves with the rest.

This core pathology of the condition stutter is found in a failure of coarticulation. To discuss this much-ignored fact, we need to define our term. When we assemble words from sounds during speech, we do not simply voice the different sounds, or phonemes, in sequence, like beads on a string. In you try to voice separately the individual sounds that make up your words, you will quickly find out what a slow process it is. In fact, even with practice, words spoken by sounding out the individual phonemes in sequence will always be much slower than simply saying the words naturally. The reason for the difference in natural speech and one-at-a-time phoneme speech is the process called coartiulation.

Coarticulation is such a subtle and natural process that it is unknown to those who use it. It is best described by an example. Think of a playground see-saw, and say the word. 'See-saw.' Now say it again, slowly, listening very carefully to the two 's' sounds you produce. If you listen carefully, you will hear that your two 's' sounds are different. This is because when you began the 's' in 'see,' your mouth (your 'articulators') was already prepared to sound the 'e.' And in the same way, when you began the 's' in 'saw,' your articulators were already in place to produce the following 'aw.' This is coarticulation, the modification of one phoneme to allow the rapid articulation of the next phoneme.

For those not familiar with the concept of coarticulation, think about it now. You have been doing this every day of your speaking life, without knowing it. There is no one 's' sound; there are different 's' sounds for coarticulating with different vowels. We all do similar modifications of phonemes every time we speak, but we all agree that however modified, an 's' is an 's,' and we don't notice the subtle distinction.

As coarticulation is the blending of two consecutive phonemes, a failure of coarticulation must be a failure to proceed naturally from one to the next. And since we coarticulate phonemes within syllables, a failure of coarticulation is more broadly a failure to properly execute a syllable in speech. This is why the essence of the stutter pathology can have nothing to do with repeating words. The failure of stutter is a failure within syllables. Anything else, however obvious to the listener, is superfluous to the essential nature of the pathology.

This failure of coarticulation, the failure to integrate two phonemes into a blended construct, occurs when the speaker is temporarily incapable of carrying out the motor process necessary to execute the intended smooth sequential transition from one to the other. I have called this failure (for want of a better term) a dynamic paralysis. It is dynamic in that occurs during a sequence of actions. It is a paralysis in that when a transition point in an intended coarticulation sequence is reached, the muscles involved in speech production stop executing the intended motor plan.

This failure to coarticulate, what I have described as a dynamic paralysis, is what is known as the stutter block. And the stutter block is the essential fact of the condition. All other observed behaviors, from the stereotypical repeats and prolongations to the 'other' of observed maladaptive speech behaviors, plus the unobserved avoidance, anxiety and fear are all the consequence of the coarticulation block. The temporary inability to coarticulate is stutter. as the inability to regulate blood sugar level is diabetes.

Continued, next entry.

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