Monday, January 16, 2012

A Proper Name: (Part II)

So now that we've nailed down what the condition known as stutter 'is' (to may satisfaction, at least), isn't it reasonable to ask that the condition have a technical name that reflects its nature? The profession saw cause to go all technical when it came up with persistent developmental stuttering (how's that for a mouthful?), so I don't think I'm asking too much. Stutter is fine for casual use. But can we not do better? I think we can.

As I've pointed out, stutter is not a random disordering of speech. When untrained people hear it, they know it. And although professionals have claimed to be unable to pin it down(!), we know better. Stutter is a failure of coarticulation, so coarticulation must be a part of any accurate name. The failure of coarticulation that occurs in a stutter block is located inside, not between, syllables. This could be described as an intra-syllabic coarticulation failure, but that would be redundant. The syllable is the smallest natural unit of speech, and syllables are by definition a coarticulated series of phonemes. While being specific, technical names should also be as simple as possible, so let's not add unnecessary jargon.

These coarticulatory blocks we've described occur in a specific manner. First, they occur intermittently. Not only are coarticulation failures actually rare, but they are not consistent. In spite of the point made in the literature of stutter that stutterers tend to block on the same words, in fact this is a statistical construct. Even 'most stuttered words' are not necessarliy stuttered; there is simply an increased likelihood that the speaker will block during that word. The intermittency, or irregularity of stutter block occurrences is, in fact, universal to the condition

As coarticulation blocks are intermittent, they are also temporary. As I described the stutter block as a dynamic paralysis, it is also a paralysis of lasting but limited duration. As with intermittency, the extended-but-transitory expression of the block is fundamental to the nature of the condition. Let me make this point. When non-stutterers make errors in their speech, as often happens, they typically correct them immediately, such that the errors are often not even noticed, much less remembered, by listeners. If the stutter block was simply a failure to coarticulate upon first attempt, then the condition would consist of the failure, followed by an immediate correction. We can imagine that such a condition could exist in a world of hypothetical speech pathologies. Those who had such a condition might be recognized to the degree that the rate of occurrence was high enough, but it would be a subtle disordering of speech, and would be a profoundly different condition than the stutter that we deal with.

At best, a technical name for the condition would recognize its core pathology and its defining factors of execution. That would be nice, but can we fit it all in? How about intermittent transient coarticulation block disorder? Nah, too much. In spite of the fact that the profession is happy to use two qualifiers in persistent developmental stuttering. Unless you follow the habit of speech pathology professionals and immediately squash it down to ITCBD, or perhaps TICBD, it's just too unwieldy. The object here was to come up with a better name, not write a book.

The fact is that there is only one speech pathology defined by coarticulation blocking. Clutterers may also suffer from coarticulation blocks, but they add their own unique disording to their speech. I think that by keeping to that which is necessary to define stutter, we can sort the two conditons out. Thus, stutter, whether childhood or persistent, could be accurately labeled as coarticulation block disorder (or CBD for all you speech pathology professionals). So it's taken 22 paragraphs, but there you are!

And what is the benefit of making such a change? The same sort of benefit that comes from sorting out chronic stuttering (persistent developmental) from childhood and injury-generated. Precision of language is crucial to rigorous thought, and rigorous thought is crucial to understanding. Stuttering is that funny thing people do. "He has a stutter" is the equivalent of "He has a tapeworm." They tell you nothing other than the two are somehow associated. Coarticulation block (or blocking, take your pick) disorder tells you in three words, once you familiarize yourself with them, exactly what is wrong here. This person doesn't have 'a' speech disorder, and they aren't 'disfluent.' They are subject to a very specific breakdown in their ability to produce normal speech.

The speech pathology community benefits from being forced to confront the core of the condition. One can read entire books written by the 'experts' and never see the word coarticulation. Of if it does occur, it is only in passing, and not tied specifically to the core of the disorder. The fact that this is true is mind-boggling. Within the therapy community, the mind-set seems to be a paint-by-numbers 'now do your easy onset,' rather than an effort to deal with the pathology from the inside out. I'll add here that I learned about coarticulation from the work of long-time therapist Courtney Stromsta, so clearly this information is available to anyone who chooses to pay attention to it. To the degree that SLP's do incorporate an understanding of the role of coarticulation failure into their therapeutic program, good for them.

There is a benefit to stutterers as well. Currently, when a stutterer asks 'what is wrong with me?' the answer is 'you stutter.' Well thanks loads. Stutterers know that they stutter - it's the nature of stutter. Few stutterers, however, have the slightest idea exactly what the nature of their speech disorder is. As with non-stutterers, they focus on the superficial mangling of speech, and add their affective reactions to their maladaptive speech. What you get is a knowledge of the obvious, with an added element of subjective confusion.

When you tell a stutterer that he/she has coarticulation blocking disorder, you do two things. First, you let them know they 'have' something, as opposed to their likely belief that they 'do' something. It is the nature of the stutterer to be in confusion, to not be able to explain oneself to oneself. This sense that 'I do something, I don't know what it is, and I don't know why' can only make the development and maintenance of a healthy identity extremely difficult. By giving the condition a name beyond 'that which it does' (stutter), the person who deals with the condition is given a place to assign the symptoms of, and responses to the condition outside of his/her essential self. Stutter does not do this. Nor does persistent developmental stuttering, which only separates out three classes of the condition.

There are many stories of people who have spent years being misdiagnosed (or undiagnosed). Typically, the story ends with the sufferer having a great weight lifted off his or her shoulders when they finally learn what is wrong with them. Even when they learn they have a serious disease, that knowledge is considered better than not having an answer to their questions. I don't think I stretch an analogy too far to say that stutterers are in a similar situation. A stutterer being told 'you are a stutterer' is little better than a person with multiple disconnected symptoms being told they suffer from a 'multiple symptom syndrome.'

And there is a benefit to the general public knowing (to the degree that the name would get to them) that stutterers are not people who happen to talk funny. Stutterers have a unique condition that results in a specific disordering of speech, which results from a specific failure of motor plan execution. The public now understands that the people who were once considered 'retarded' have a particular condition, called Down syndrome. 'Retarded' was (and still is) synonymous with 'stupid.' Down syndrome is not synonymous with stupid; it points to an underlying condition to which the person is subject to. As such, it makes no sense to 'blame' such a person for 'being stupid.' A person with Down syndrome lives their life within the limits of their condition, and are today judged within those limits. If the speech of stutterers were judged in a similar manner, rather than against the speech of those who do not have the condition, we would all be far better off.

And finally, all; professionals, stutterers, and maybe even the general public would benefit from the education that would be provided by the introduction of the new term. A change to coarticulation blocking disorder would invite the questions 'what the hell is that?' and 'why are they changing the name?' Which is exactly what I would want. The central fact of stutter is essentially ignored in the speech pathology profession and unknown by those who deal every day with the condition. A dramatic (re)education on this matter would benefit us all.


  1. Why not call it dynamic word dependent paralysis (DWDP), because that's what the condition actually is.

  2. First, because stutter occurs in syllables. We think in terms of words, but we speak in terms of syllables. And second because its word probabilistic, not dependent. No one stutters only on certain words, as far as I know. There is a statistical tendency to stutter on the same words when re-reading the same passage, but I don't believe that holds with different passages, and the effect wears off over time.