Stutterology

Why 'Neurogenic' Matters

2012-02-03T13:15:00.001-05:00

Commenter Ora was kind enough to make a thoughtful response to my last post on why 'neurogenic' and 'developmental' stuttering are not are not good complementary names for the two related conditions. This raises a classic blogging issue - with no editor to pre-read and review copy, a writer can never be sure that the intended message is getting through. I know what I think, and I know what I want to say, but I can't know that I'm writing well enough to make my point.

My previous post on the use of the term 'neurogenic' was intended to be short, as a respite to my usual long-winded (blog-wise) entries. Let me take the opportunity to elaborate on the important reasons why I think it's worth making the neurogenic distinction.

First, regardless of the importance of learned behavior in the confirmed developmental stutterer, the condition of developmental stutter either is or is not of neurogenic origin. I happen to believe that the evidence, both direct and indirect, is sufficiently strong to favor a neurogenic origin as a default assumption. If this is true, then the term neurogenic cannot logically be used to distinguish the developmental and acquired versions of the condition. Even if one is not fully convinced that developmental stutter is always neurogenic in origin, there is sufficient evidence pointing in that direction to make the developmental/neurological distinction a poor one for distinguishing the two types of stutter.

When a child starts to show signs of stuttering, an obvious question is 'why?' What is causing the disordering of the child's speech? For decades, many believed that children naturally spoke imperfectly, and gradually 'learned' to stutter. This was always an assertion, rather than a theory or even hypothesis, and it was wrong. The weight of evidence favors the belief that children start to stutter during their speech development process because they have a neurological deficit of some kind. Whatever happens later in life, the beginning stutterer has a neurological condition, and retains that condition as long as they stutter. That there are learned elements to chronic stuttering is certainly true. However, if one were to strip away the learned behaviors (eye blinks, head jerks, forced articulation, improper breathing, etc) from the basic neurological element - the block - what would we be left with? My answer is: a stutterer. Thus, there is the (neurological) condition - stutter - and there are the behavioral and affective responses. Should a condition be defined by its fundamental nature, or by the response to it?

A particular (and practical) motivation for my emphasis on the neurological basis of developmental stutter is the support such an understanding could give to stutterers themselves. For any stutterer, the knowledge that their condition has a specific, organic source rather than just 'something that happens' could be a comfort when dealing with it. Based on Internet stutter groups, many stutterers don't have the slightest knowledge of the condition, and old wives tales are as common as science among the afflicted. When you have people insisting that 'you can catch it,' we shouldn't be surprised that so many stutterers have difficulty dealing with the condition.

A specific case for the value of defining developmental stutter as neurogenic would be in cases of therapeutic relapse. Stutterers who go through stutter-suppressing therapy like fluency shaping can find that a relapse leaves them worse than when they started therapy. This can induce guilt and depression over the lost 'fluency. If one started with the understanding that developmental stutter has a neurogenic basis, it would be easier to accept the possibility of relapse. Under the neurogenic assumption, stutter therapy is an attempt to 'fight city hall.' If we are trying to fight the wiring of our brains, rather than 'bad behavior,' then we can understand why it should be so difficult to eliminate stutter blocks entirely.

A stutterer grounded by an understanding of the neurogenic basis of the condition should be less likely to experience such high highs (assuming their stuttering is 'cured'), and low lows (crashing and burning after relapse).

To commenter Ora's point about therapy: by it's nature, all stutter therapy must be behavioral. Drugs have been tried, and found wanting. We can't get at the brain, so we can only make conscious efforts to modify speech. I don't think there's any fear of taking away from this necessity by stressing the neurological basis of the condition. Until there is some fundamental breakthrough in treatment, stutter therapy can only involve three elements; cognitive, affective and behavioral. That is, we can learn about the condition, we can learn about how the condition affects us emotionally, and we can learn to modify the actual speech process. My stress on the neurogenic basis of stutter is part of the cognitive element. Alone, it does nothing to change speech. It could, however, serve the therapeutic process by setting parameters. Stutter is not a behavioral bad habit, simply to be unlearned. The learning process of stutter therapy is a process of actively learning to deal with the neurological element - the block. To me, this is the critical issue of stutter therapy. The piano student must master the challenge of difficult finger movement and coordination. But for all the difficulty of mastering the piano, the piano does not fight back. The neurological abnormality that triggers the stutter block does. One doesn't practice a away stutter and become a normal speaker - at least very few do.

Although most stutter therapy doesn't actively raise the neurological issue, most deal with it implicitly. The fluency shaping approach doesn't explicitly rule out a neurological basis for stutter, but it does work on the assumption that either there is no such basis, or that it can be over-ridden through training. The stutter modification school of therapy isn't based on a neurological theory, but it provides pragmatic treatment as if it did. Both schools of therapy engage in behavioral therapy, but the two are very different in outlook and in practice. By insisting on bringing out in the open the biological nature of the condition, we implicitly demand that different schools of therapy justify themselves to the facts of the condition.

Neurogenic or Acquired Stutter?

2012-01-23T07:00:00.002-05:00

Even CNN knows!

I happened to find this clip after I wrote the text for this entry.

Just when you thought there couldn't possibly be any more stutter word police, I'm back with more! This one only came up because I met a man with a neurogenic case of stutter last week. Neurogenic stutter describes a condition that comes on due to either physical damage to the brain, through injury or stroke, or secondary to a disease like Parkinson's. Neurogenic stutter can also be caused by prescription drugs, and may disappear when the drug or dosage are changed.

Until now, it hadn't occurred to me, but using neurogenic in opposition to developmental stuttering is not proper usage. And in fact, there is another, correct term used: acquired stuttering. These two terms correctly differentiate between a condition that comes on during development and one that is not development-related, but is 'acquired' regardless of the developmental process.

The Stuttering Foundation has an informational web page for neurogenic stuttering here. Interestingly enough, in the reference section, they cite multiple papers that use the term 'acquired stuttering,' and two using 'acquired neurologic(al).' So obviously, the profession hasn't made up its mind on this subject.

My preference goes beyond wanting to align the rationale for the two terms along logical, developmental/non-developmental lines. The reason is that I believe that the evidence is clear (to me, at least), that developmental stutter is neurogenic. The only difference between the two conditions is that one results from existing neurological abnormalities and is expressed during development, and the other is expressed when damage is done to an otherwise healthy neural speech system.

As a practical matter, the shift away from using the term neurogenic stuttering would require pointing out to people in the field that no, developmental stutter is not 'learned.' It has an organic, neurological basis, just like acquired stuttering. This is another effort on my part to stick a fork in the effort to save learning theory and sneak it past the door. Stuttering is not learned. Whether it is always an inherited condition or not is not proven, but I am confident that it is organic, and distinction not made often enough. There are those in this field who give lip service to acknowledging the evidence for the organic basis of stuttering, and then sneak behaviorist learning theory in the back door. The less places they have to hide, the better.

Take-home message: Acquired stutter, good, neurogenic stutter, bad.

A Proper Name: (Part II)

2012-01-16T07:00:00.001-05:00

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.

A Proper Name: Part I

2012-01-09T07:00:00.002-05:00

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.

Knowledge > Empathy

2012-01-02T07:00:00.000-05:00

Within the speech therapy community, there is a wing that actively promotes the virtue of empathy. That is, therapists are told the value of empathizing with their clients. I think it is reasonable to say that the empathy-based practice is being contrasted to the 'speech correction' emphasis of the fluency shaping school of stutter therapy. So the empathy-based practice is rooted in a primary concern for the psycho-social elements of stutter, while the fluency shaping seeks to eliminate all stuttering, and in doing so, eliminate the cause of any psycho-social disturbance.

Now speech therapy is a helping profession, and in such fields it is always good for the clinician to be a people person. If one is going to help people deal with their problems, a misanthropic or uncaring personality is going to struggle to enjoy the work. I am, however, wary of a special emphasis being put on empathy.

Empathy is not a (cognitive) understanding of the feelings of others. Empathy is the ability to recognize the feelings of others, and to feel with them. In five minutes, I can tell anyone in dramatic terms what it is like to be a stutterer. I can share the usual suspects of the stutterer's inner life; the childhood traumas, the self-doubt, etc. And once I tell them, they know what they need to know. I have no interest in their 'feeling my pain,' although I do see the value in their understanding it. And that understanding is not empathy.

If I went to a speech therapist, I would want her/him to know what works and what doesn't. I would want them to be able to personalize their particular method of therapy to fit my situation. And I would want them to know what to expect from me as I attempt to follow their direction. In other words, I would want knowledge and experience. I would not want hugs, of any other such touchy-feely-ism. My problem is not a lack of love - my problem is a speech pathology. That's why they're called speech pathologists, no?

The affective aspects of stutter play a huge role in the condition. Stutter is a pathology of speech communication that has a major role in social relations and in personal identity. Put simply, being a stutterer is a bitch. But I would far rather have a therapist totally lacking in empathy, but with a deep understanding of both the objective and subjective experience of stutter, than a deeply empathetic clinician who followed a therapeutic script without understanding of the condition.

There may be times when it is advantageous for therapists to play the 'I feel your pain' card, but that could be done based on the practical value of doing so, without any particular empathy-based feelings. What is needed, in such cases, is not a sharing of feelings, but an understanding of how the client's feelings are getting in the way of therapeutic progress.

I have no doubt that the negative baggage we stutterers carry is the single greatest barrier to long-term success in therapy. My efforts on this blog have been focused almost entirely on stutter as a pathology of speech, in reaction to the non-speech emphasis I've found so often in discussions of stutter. That does not mean that I don't see value in understanding and coming to grips with the affective, reactive elements of the condition. But I see no reason to raise empathy to anything beyond a starting point for those in the helping professions.

Knowledge is power; empathy is not. Ultimately, there is something wrong with a person who stutter, and that something needs to be dealt with as far as is possible. Doing so requires understanding on the part of the therapist and the client as well. The more stutterers understand of their condition, and how they react to it, the less you will see anything to be empathetic about.

The Genetics of Stutter - A Review

2011-12-28T07:00:00.003-05:00

I've just found a very nice review of the 'Genetic Bases of Stuttering: The State of the Art, 2011,' written by S.J. Kraft and E. Yairi. This paper is a nice summary of the historical work on the subject, with an up-to-date look at the most recent work. In it, you will find no wooly-headed thinking, no Just-So stories, and no perverse clinging to long-dead 'theories.' Thank God, they stick to science.

I suspect you'd need at least a college biology course to follow the different discussions, but the paper is not written for geneticists, so it is not burdened with too much jargon, and it's not a research paper, so it's not filled with graphs and charts. Give it a try. The link to the full, free version is at the top right of the page.

Get it here.

Fear of What?

2011-12-19T07:00:00.000-05:00

If you do an Internet search on stutter, you'll find that among the most common terms associated with the condition are fear, anxiety, shame and the like. If you read stutter message boards, you'll find stutterers discussing their frustration, embarrassment and anger at having to deal with their condition. Clearly, negative feelings, however expressed, are a very real part of the life of stutterers.

If you dig further into the literature on stutter, you'll find a common claim from therapists and researchers that stutterers overestimate the degree of negative attitudes held by their listeners. Commonly, it is said that stutterers 'project' their own feelings on to their listeners. No doubt, there are some people who harbor negative attitudes towards stuttering, and some express them openly when they encounter it.

In order to justify putting the onus for causing the stutterer's fear/shame/anxiety/etc. on the listener (given that this fear is typically felt before the stutterer even begins speaking ), we have to reach past the actual behavior and attitudes of listeners and speculate. One can argue that the fear comes from past experience, in which listeners did show hostility or ridicule, or simply impatience. This is a reasonable speculation, to a degree. How often, and to what degree does it apply, however?

Our experiences are all different, but how many stutterers suffer repeated, long-lasting persecution for their speech? For those who have suffered ridicule and bullying from schoolmates over time, it would be understandable that they should think the worst of non-stutterers. I suspect, however, that such cases are the exception rather than the rule. And given the natural cruelty children are capable of, I doubt most stutterers have suffered any more than many other children at the hands of their peers.

I would suggest that 'past experience' is only a partial answer. If eight out of ten non-stutterers treated stuttered speech with ridicule or disdain, it would be reasonable. I can only speculate, but I believe that the true proportion of people stutterers interact with who respond negatively is far smaller than four out of five. If positive - or at least neutral - experiences are the rule rather than the exception, then why the emphasis on the negative? Why is the evidence of fear and anxiety so much greater than the evidence for a rational basis for such feelings?

Let me make a suggestion as to the origin of the famous stutter-anxiety - one that might explain both the consistency and the degree of the phenomenon better than the 'listener reaction' hypothesis. It was William Perkins who suggested that stuttering be defined as a loss of control over the speech process. My hero in the field of stuttering, Marcel Wingate, derided this idea, but in this case I think he was wrong to do so.

The difference between stuttered speech and the normal flaws of speech by non-stuttering speakers is exactly the loss of control over the speaking process that is experienced by the stutterer. This is related to my antipathy to the rat-bag term 'disfluency,' which includes stuttering, as well as every imperfection of speech by those who do not stutter. A non-stutterer can be trained to clean up their speech to perfection, as professional public speakers like television and radio announcers, and (some) college professors do. Removal of interjections like 'umm' and 'uhh' are just a matter of paying attention and practice. That is, while they slipped into the speakers manner of speaking casually, they can be removed volitionally

The disordering of speech produced by stutter are another matter entirely. The blocks that generate the stereotypical prolongations, repeats and the assorted rest are not a bad habit; the blocks are generated beyond (under, within?) the level of voluntary control, and as such are only subject to conscious decision to a slight degree. Perkins was right in his assertion; what separates the stutter block(and the tics of Tourette syndrome, for instance) from other 'behaviors' is that they are generated at a sub-conscious, sub-voluntary level, and are not subject to what we commonly think of as 'will power.'

It has taken my multiple paragraphs, but I can (begin to) get to the point now. I'd like to propose that much of the fear, embarrassment, etc., of stuttering is not so much the fear of negative judgements by others. Rather, it may be the fear of experiencing the lack of control over one's own body that occurs during a stutter block, projected on to others.

You can read books and articles on stutter for hours and barely see a word about the core of the condition: the physical inability to proceed through the normal production of a spoken syllable. Stutterers are not bad at speech, as I might be bad at hitting tennis ball or painting a portrait. Stutterers suffer a temporary fault of speech production, in which the expected motor process cannot be carried out. This is in spite of the fact that in other cases, the stutterer is perfectly capable of saying the same word perfectly. Stutter can be described as a dynamic paralysis (although I've never seen it put that way), in which a typical series of physical movements is stopped in mid-sequence.

Imagine that you decide to write something down. You see a pen on your desk, and reach for it. Your elbow extends, your upper arm raises in your shoulder joint slightly, your wrist turns to face the palm of your hand down, and just as your fingers begin coming together in preparation to grip the pen, your entire arm locks up and will go no further. What's going on? Your arm comes back to your body, you raise your hand to look at it, you shake your hand at the wrist, and then you repeat the above process.

You reach down, get to the same point as last time, and again, just as you prepare to grip the pen with your fingers, your hand and arm lock up. Now you strain to force your hand down to reach the pen, but in spite of your arm muscles quivering, you can't get your fingers any closer to the pen. You pull your arm back, rub it with your other hand, shake your whole arm this time, and start over once more. And the same thing happens. After 5-6 attempts, you finally find yourself able to grab the pen roughly off the desk. How would you feel?

What I've done here is to model the stutter block with hand and arm movements. I've also eliminated any observer effect. How would you react to being suddenly incapable of controlling your own body in what has always been a natural - and necessary - series of motions? How would you think of your own arm if it suddenly seemed to be disconnected from your will? What does it mean to say 'this is my hand' when the hand won't respond to sub-conscious level control as it always has? It seems to me that this kind of dynamic paralysis of normal motor function would be terribly disconcerting.

Now add another element to this phenomenon. Make it intermittent. Sometimes you can pick up the pen, and sometimes you can't. Sometimes it's bringing a fork to your mouth while eating. Sometimes turning the ignition key when you want to start your car. And sometimes it's getting your penis out of your fly when you need to urinate (use your imagination, ladies). I think you can see how this sort of intermittent loss of control of one's body could easily be traumatic to the psyche - independent of any 'listener effect.'

I am proposing here, that a significant part of the fear/anxiety/shame that is discusses so often around stuttering originates not in the stutterer's understanding of how they will be perceived by others, but in the stutterer's own body. I am proposing the existence of a quite natural sense of dread that comes out of the loss of control over the stutterers's body during a block. That such a sense of wrongness should be directed outward to listeners is also quite natural. How many stutterers stop and analyze their own condition during those moments of blocking? Who calmly and rationally studies the nature of their stutterings, and considers the origins of their anxiety?

The nature of stutter directs us to look outwards when we examine our own physical and psychic responses to moments of stuttering. When do we stutter? When we talk. When do we talk? When there is someone to talk to. It is easy to take the next step and say that our listener causes us to stutter. Of course, here we must note the maxim from statistics: correlation is not causation. A good deal of science goes into supporting that statement against 'common sense.'

So to 'deconstruct' the 'listener effect' in stuttering anxiety, we could say that just because a listener is in front of us when we feel anxiety during speech, that doesn't mean the listener is causing the anxiety. Listeners, and any perceived negative attitudes held by then, could just be the hook we hang our anxiety on when we haven't looked inwards to find the source.

This is not to say that bad attitude on the part of non-stutterers isn't real. Any stutterer knows that. To a greater or less degree, we've all experienced the insults and various degrees of negativity, from being ignored to being beaten. My effort here has been to account for the difference between the degree to which real harm that can be inflicted on us (limited, and generally less than we think) and our internalized level of negative feelings.

So once again, the reader might ask 'what's the point?' In this case, I would argue that the point is a big one. Stutterers are notoriously resistant to speaking openly, and to the therapeutic path. Stutterers are even resistant to dealing with other stutterers. The first time I saw a stutterer on television as an adult, I was shocked. I found it hard to keep watching, it was so painfully uncomfortable for me. My native Boston metropolitan area has 1.8 million residents and two National Stuttering Association support groups. When I attend my local group meetings, we get from two to five stutterers. That's one stutterer at the meeting for every 1800-4000 stutterers.

Why is this? Why are stutterers so averse to their own condition that we are so resistant to acknowledging it and dealing with it? You can say fear and shame, but those words just raise the question 'why?' Why is the distaste for our stuttering so great that so many of us can't even begin to attempt to deal with it? My suggestion is that the source of our anxiety is deeper than has been acknowledged in the past.

Even if we understand cognitively that listeners won't point and laugh at us in public if we stutter, the interior source of anxiety remains. That feeling, experienced thousands and thousands of times over by the time we reach adulthood, that our body is not our own. The feeling that we are, in a sense, possessed during the moment of speech block, and have had our bodies severed from out intentions. Something not 'us,' not our thinking, volitional selves, is getting between our intentions and our most human of behaviors. When that which makes up our inner self is divorced from our physical self, should we be surprised at the outcome?

Scanning : Stutter-Style

2011-12-12T07:00:00.002-05:00

Horror fans not familiar with his work should check out the movies of director David Cronenberg, including the 1981 creep-out Scanners.

It is commonly said (by stutterers and others) that while speaking, a stutterer will scan ahead to look out for 'difficult' words. An Internet search for [stutter + "scan ahead"] will verify the popularity of the idea. The word scan, taken literally, implies looking. We scan text on a page. We are able to do so because the text is, in fact, already on the page and available to be scanned. While we can take the word scan figuratively, as might be argued by some, the fact is that the word scan implies sight, and sight implies written text. This sort of confusion between spoken and written language shows up repeatedly in the stuttering literature. I'd like to question the degree to which such scanning actually occurs, and to what degree the analogy to a visual process (scanning) obscures rather then elucidates whatever it is that is actually happening.

First, let's look at the claim. Upon recognizing a difficult word coming up, the stutterer may insert a synonym, rephrase to avoid the word, or start an entirely new sentence in mid-speech. We need not rely on the word of stutterers for such mid-sentence changes. A recording of a stutterer talking studied closely will often reveal a pause, mid-sentence, followed by a grammatical mash-up that produces a new finish to the sentence that is divorced from what came before. A very similar kind of sentence breakdown is actually common in the casual speech of non-stutterers, and is often unnoticed by the listener. Transcripts of the extemporaneous speech of politicians that include such verbal inconsistencies have, however, been used (unfairly) to embarrass them by their opponents in the media. What is ignored (and acceptable) during speech becomes obvious on the page.

The fact this sort of word avoidance and sentence restructuring by stutterers occurs does not, however, necessarily support the idea of scanning. That is, if the decision to avoid a 'difficult' word doesn't come until the word is arrived at, then there was no scanning. Scanning implies looking ahead multiple words in a serial sense, and the behaviors of word replacement or sentence restructuring does not prove that scanning has occurred.

So how far 'down the page' (figuratively) can a speaker scan when he or she doesn't normally know exactly what they will say until they say it? Speech is a subtle and complex process by which vague, unformed ideas become words in grammatically ordered sentences at a rapid rate without conscious effort. So how much scanning of upcoming speech can a stutterer actually do?

Surely we cannot imagine that anyone can know in any but the rarest cases what is coming two sentences ahead during spontaneous conversation. The best one can say for words outside the current sentence is that if one is discussing Abraham Lincoln, there will be a time when one is going to have to say the name Abraham Lincoln, the word President, and other such terms necessary to the topic. We may perceive that while we speak on sentence, the next sentence will logically have to include Lincoln's name, or 'the President,' but that is not 'scanning,' in any non-stuttering sense of the word.

Putting aside such cases in which it becomes obvious that a word will have to be spoken some time soon, what can we say about the realistic possibility of 'scanning' ahead in speech? When we begin a spontaneous sentence, we do not have in our conscious mind how it will end. Sentence construction is done on a subconscious level, while we observe our listener, wait for the coffee machine to finish cycling, and wonder what that unpleasant smell is in the office lunch room.

The actual work of scanning, so-called, can only occur when a decision has been made to use that word in a particular sentence, in a particular grammatical construct. And given that in spontaneous speech one sentence cannot be logically constructed until the previous sentence is already known, we have to assume that the horizon for knowing upcoming words is very short.

What it comes down to is that it is difficult to imagine how one could scan for a word in the second half of a sentence until already engaged in speaking the first half. One could say that we need to know where our subconscious speech production center is taking us before we can know what our next steps will be.

Let's look at some examples. In a simple sentence of a single clause, the final words of the sentence may come to our conscious mind after we have said the first few words. This is not a matter of scanning ahead; we simple know where the logic of the sentence is going before we finish speaking it.

In a longer, more complex sentence, we may perceive the words that will begin a second clause as we approach speaking the end of a first clause. This may also be true of sentences. We may know as we finish one sentence how the next sentence will begin. This is less a matter of scanning that of gaining consciousness of the next few words in a package immediately before we speak them. We could make an analogy to walking in the woods. We do not scan up the path to prepare for rocks and roots on the ground. Rather, we keep an eye on the path immediately in front of us, and adjust our footfalls only as we reach the obstacle.

We can now ask whether this process, whatever we call it, is unique in any way to stutterers? Does it really require a life-long experience with a speech pathology to be occasionally conscious of the next few words to come as we speak? Being a stutterer, I can't speak for non-stutterers, but I suspect the answer is no. A reasonable assumption is that everyone becomes aware of upcoming words as they become 'next in line' for speech. For the normal speaker, this awareness is ephemeral and trivial. They might use it to edit themselves, but the operation would be a barely conscious one.

To sum up: I believe that what is being described by the term 'scanning ahead' is not scanning at all. The fear of saying certain words - and of stuttering while doing so - is not scanning. The consciousness of immediately upcoming words during speech could only be called scanning by stretching the word to its breaking point. A page of text can be scanned down a few (several?) lines while reading. Paragraphs of speech yet to be formed in the mind cannot be scanned under any effort of the imagination. The knowledge that certain words are associated with particular subject is not scanning - it is a static state rather than an active process. So while the term 'scanning ahead' points to a very real phenomenon - an effort of circumlocution to avoid a stutter block - the word can only suggest to non-stutterers something far beyond what actually occurs.

And why does it matter? It matters because this field is so full of obscurantist language that it is difficult to discuss the pathology using the standard jargon without necessarily being led astray by the very terms themselves. Word fear is very real, and can interfere with communication when it results in meaning-destructive circumlocutions. And that process of generating any such circumlocutions can, in itself, reinforce the fear that began the cycle.

I would suggest that rather than scanning ahead for difficult words, stutterers are simply alert to the occurrence of such words in their speech as they bubble up in consciousness. Anxious alertness would be a better descriptor than the 'scanning ahead' cliche found so often in the literature of stutter.

Role Models Revisited

2011-12-05T07:00:00.002-05:00

In an earlier entry, I discussed the standard list of 'famous stutterers' that we see so often. While re-reading that entry before writing a new post, I was reaquainted with the following comment:

"Hi Mark, I think there is huge benefit in studying those who have managed to improve their fluency or have cured themselves. In many cases it would seem that career success has improved their confidence, so weakening the stutter to a point where it is no longer an impediment. Confidence seems to be a major ingredient in improvement. I believe this is due to the fact that confidence reduces tension levels, so improving fluency. Regards."

I'll use this response to my more critical take on stuttering role models to amplify on my concerns. Let's start with the list provided by The Stuttering Foundation. The list is too long to copy and paste here, so I'll refer to it and encourage you to read it for yourself.

I'll put these people into categories other than the ones listed on the web site. First, there are the professional speakers: actors and politicians. Their relevancy to stutterers is that when they do speak in public, they never stutter. These would be the people refered to in the quote above.

The professional speakers actually fall into two sub-categories - those who have experienced effective recovery (they don't stutter any more), and those who have gained what might be called a 'situational' recovery. The first group are part of a very rare minority of persistant stutterers who simply stop stuttering. Whether this is because of their acting or public speaking experience, or whether they were bound to recover in any case cannot be said for sure. What we know is that they are rare exceptions to the rule of persistant developmental stuttering.

So what do stutterers learn from those who have recovered? Is drama class the cure for stuttering? I see no suggestion in the stuttering therapy literature that it is. I would speculate that those who do recover are likely to come from the mild range of the condition, and are probably more amenable to the powers of suggestion and 'confidence.' It is difficult to gain such confidence when the first attempted word is mangled by a seconds-long struggle. For most stutterers, surely this is not a reasonable path to follow.

The second sub-category of professional pubilc speakers fall under the heading of situational or performance recovery. I believe that actor James Earl Jones belongs in this group. As well noted in the literature, some stutterers can speak without blocking when adopting a 'different' voice. This can be an accent or a caricature voice, or through adopting the role of another person, as in acting.

This sort of stage 'cure' for stuttering is certainly interesting in an academic sense, but what does it do for stutterers? There are only so many acting jobs available, so actor is hardly a profession to which stutterers can reasonably aspire. The performance 'cure' is really a sort of trick - a dramatic (pun intended) one, but a trick none the less. The fact that some stutterers can pull it off while still stuttering in 'normal' life is interesting only in the sense that it is a curiousity. If it was any more than a curiousity, then we could all use the same 'trick' in school or in our jobs. We can't.

Also in the first group are singers. Of course, we know that many stutterers can sing without any sign of stuttering block. This is one of those curious facts of the condition. What does it tell us that Carly Simon and Marc Anthony and John Lee Hooker stuttered? They are successful through their voice, but not through their speaking. And stuttering is a speech pathology, not a voice pathology. These are/were very successful people, but their success did not come from 'overcoming' their speech disorder. Their success came from sidestepping it. I don't know how severely the singers on this list stutter, but as far as I know only Mel Tillis was known by his audience as a stutterer. And it is Mel Tillis who makes my (very) short list as true role models. More about that later.

Next on the list is athletes. These are people who are rarely if ever called upon to speak during their day-to-day jobs. I'll note here that I live near Boston. Damien Woody played at Boston College, and then spent five years with the local New England Patriots. In all the time he was here, I never heard a mention of his stuttering. To what purpose is his name put on this list? If you are 6' 3" tall, weigh 320 lbs, and can move like a cat, and stutter, you too can be a professional athlete? I've seen Tiger Woods interviewed, and I've seen no evidence of stuttering. If I wasn't told, I wouldn't know. Again, if you have freakish skills hitting a little ball into a coffee cup, you too can be rich and famous.

I'll add to my short list by citing Johnny Damon. As a Boston resident, I learned that during his time with the Boston Red Sox, Damon successfully dealt with his significant stuttering to the point where he could do radio interviews. It was clear during these interviews that Damon stuttered, but he was willing to put himself on the spot, and was able to communicate clearly and without obvious stress or serious blocking.

The writers? The best that you can say is that the writers prove that you can be successful in life and even famous if you find a career in which you never have to talk. I think we already knew that. Maybe for children this could show that stutterers are as smart as anyone else, but how many children will be impressed by John Updike and Somerset Maugham?

The short list of journalists include the recovered like John Stossel, and tycoon Henry Luce, of whom we know nothing related to his stuttering. Was it mild or severe, or did he recover as well?

The politicians include people like Joe Biden, Frank Wolf and Tom Kean, who don't appear to stutter at all. Their cases can be looked at in two ways. First, their example holds out the hope that you, too can be one of the tiny minority of the 'cured,' and go on to success. To what degree lottery winners should be role models for investors is open to debate - to say the least. On the other hand, given that there are no stuttering (as opposed to formerly stuttering) politicians today that I am aware of should tell you that if you do stutter, there is no evidence that you have an icicle's chance in Hades of being successful in American electoral politics.

Then there are the business tycoons. Like the politicans, I suspect we're dealing entirely with the recovered. I've heard Jack Welch and Stephen Brill speak, and neither stuttered. A quick trip to YouTube shows that John Sculley intersperses his speech with momentary pauses that could, theoretically, be the remnants of a former stutter. On the other hand, let's face it - he doesn't stutter. The same two possiblities as above hold here: either you can use these people under the 'you may be one of the lucky few' banner, or you can accept that if you're going to be successful in business at a high level, you can't stutter.

The Moses and Demosthenes thing? Please - don't embarrass yourself. They may as well be King Arthur and Hercules. They are there just to pad the list.

So let's summarize my take on 'Famous Stutterers' lists. They are grab-bags of those who don't stutter and are successful, those whose careers depend on their not having to talk and are successful, and those whose careers depend on their not having to talk and are successful while also talking to the media. The latter consists, as far as I know, of Mel Tillis, Johnny Damon and Bill Walton. And Bill Walton may be a case of situational recovery, with his television appearances being done in 'performance' voice.

The best I can do is to say that these lists show children - and adults who don't stop and think - that they are not inevitably doomed to failure in life. This is true, in a literal sense. Unfortunately, it is also true that Mel Tillis is the only person on the list that I know of who became famous on a national level while being known - and observed - as a stutterer. And his stuttering was incidental to the performance of his profession. I know of no other person successful on a national level who stuttered openly on national television. The only other person who comes close to fitting the bill is Johnny Damon, and he spoke rarely and only to a local media market.

Tillis and Damon are people you could point to and tell your children "see, they stutter and they don't let it stop them." They were not only successful, they were successful while being stutterers. I think that is a far more powerful message, given what we know about success rates of speech therapy, than "if you can stop stuttering entirely- somehow - you can be successful like (fill in the blank) too!" Giving stutterers hope by way of the 'cure lottery' surely must end in tears for most stutterers.

Now that I've been thoroughly negative (again), I'll take some responsibility and suggest how it could be done better. The list we need is not basketball players and singers and recovery freaks. Far better would be to find stutterers who are successful in their professions, and still stutter. That would include those who have their condition mostly under control, but are still subject to some speech disordering.

A stuttering engineer from New Jersey who has received three promotions at his workplace would be a far better 'role model' to my mind than a long list of 'Famous People,' most of whom do not, in fact stutter. A stuttering pizza shop owner, or a stuttering plumber would be more comforting to the average stutterer than a Hollywood actor who makes a living out of perfectly controlled speech. Most stutterers will be far more concerned with getting and holding a job that will cover a mortgage and pay for a child's dance lessons than being 'famous.'

The replacement of 'famous' (mostly former) stutterers with stories of successful stutterers who are just 'normal people' is what stutterers - particularly young stutterers - need. Not Moses and a Hollywood actress you've never seen stutter. And while I'm at it, a photo gallery of the hot wives (and husbands) of stutterers would serve a valuable purpose as well. Think about it - do teenage stuttterers dream of being Joe Biden? I don't think so. On the other hand, attractive companions are rarely far from their minds.

I'm serious about this - a single 'hot spouse' photo could do more for teenage morale than one hundred captains of industry or professional athletes and all their money and fame. Can someone get on this?

"You Tell Her - I Stutter"

2011-12-02T21:19:00.002-05:00

Bill Murray, 1923.

Stutterers Who Stutter

2011-11-28T07:00:00.004-05:00

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.

You are fluent (really!)

2011-11-22T01:46:00.005-05:00

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.

Stuttering Treatments of the Past

2010-04-11T14:28:00.002-04:00

In a 1992 article in the Journal of Fluency Disorders, Charles Van Riper told of how he and fellow graduate student Wendell Johnson served as experimental white rats at the University of Iowa during the early 1930s.

"Our brain waves were checked; needles were inserted into our tongues and the nervous impulses recorded on the smoked drum of a kymograph; we took various drugs - cocaine, hashish, mescaline to see how they would affect our speech."

Now there's some interesting research. Not the needles in the tongue part - the other stuff.

The Bates Appliances - 1851

2010-04-03T19:09:00.003-04:00

Guaranteed to work first time, every time.

Go Taboo Yourself

2010-03-22T16:52:00.004-04:00

The following passage comes from George H. Shames and Herbert Rubin in the book Stuttering: Then and Now.

"Talking about stuttering is a social taboo. Even in households with disfluent children, overt commentary is the exception rather than the rule. Taboo subjects tend to surround themselves and the members of the problem with a sense of shame and guilt which, together with a sense of victimization and helplessness, can continue through adolescence into adulthood.

For adult stutterers the social ritual proscribes any comment about disfluent speech, with the possible exception of the stutterer himself, in the form of a joke or an excuse. Neither the family nor friends risk the embarrassment of commentary, as if they were confronting the emperor without his clothes, conspirators in denial."

This is a remarkable statement. Let's look at your average stutterer: filled with guilt and shame, helplessness and a self-pitying victimization, making jokes or excuses for their behavior. And the stutterers family and friends? They can only feel embarrassment when faced with such a person.

Nice.

I'm 55 years old. As a child, my parents rarely talked about my stuttering. Not out of a sense of embarrassment, but because there was rarely anything to talk about. What would you say to a blind child - "How's the lack of sight going?" If I wanted to talk about my speech to my parents, I did so. Otherwise, they treated me like a son, not a stutterer. I knew I stuttered, they knew that I stuttered, and we all dealt with it. There was no taboo, no guilt, and no shame. I was often frustrated, but certainly never thought of myself as a victim, and helplessness never entered my mind. I stuttered - I wasn't paralyzed in a bed.

As to friends - I can't say what was in their minds. but as with my family I rarely discussed my stuttering with them. No denial, no avoidance, no shame or guilt. Just a simple principle - it wasn't there problem, it was mine. To be a friend - or a girlfriend - was to be a person who could deal with it. If a person found it embarrassing to consider, then I assumed that they would not choose me as a friend.

Within the Stuttering Industrial Complex, there is a strong contingent that loves to talk about fear, guilt and shame. And anxiety... don't forget anxiety. I've certainly lived with the fear of stuttering, but the fear was situational. I didn't spend my childhood living in fear, and my adult life has been remarkably ordinary. Guilt? Why in the world would I feel guilty? Stuttering is a pain in the ass - not a sin or a crime. As to shame, there's been some of that over the years, but again it was always situational. At my worst - those memories that stay with me to this day - the feelings of shame experienced when stuttering were generally gone the next day. As with a broken leg, you remember that it happened, but you don't remember the pain.

It is my impression that the people who want to peddle guilt and shame to stutterers belong to the school that holds psychology at the heart of stuttering. And they need fear, guilt and shame to motivate the condition. Are there stutterers who see themselves as victims? Pathetic, self-hating creatures surrounded by pitying observers? I'm sure they're out there. I'm also sure that many stutterers are well-balanced people with no need to wallow in the misery expected of them by stuttering "experts."

Stuttering Technology - 1955

2010-03-19T20:57:00.004-04:00

The Stammercheck. Don't wait - order now!

The One Percent Challenge

2010-03-12T15:45:00.003-05:00

There have been many proposals for the cause and nature of stuttering. From thick tongues to parental misdiagnosis and brain mis-wiring, the history of the topic is littered with a long list of hypothesis, from the ridiculous to the reasonable. Too often in the past, these proposals were made with little knowledge of the condition, and supported without any effort to test them against observations.

There are certain observations that are repeated throughout the stuttering literature. Stutterers are fluent when speaking in unison with others, anxiety triggers stuttered speech, many children recover from stuttering at an early age, etc. Any hypothesis proposed to explain stuttering needs to account for these, and other observations - the hypothesis cannot conflict with the facts as we know them.

Of the most significant facts of stuttering is that approximately five percent of children go through a period of stuttering, and approximately one percent continue to stutter through their lives. Any proposed cause or explanation must be consistent with these numbers.

We can start by asking whether the numbers are correct. Over the last 100 years, there have been many estimates of stuttering prevalence. Although it was once claimed that some cultures did no have stutterers or words for stuttering, it is now believed that every culture in the world knows stuttering has has stuttering members.

Beyond the existence of stuttering, we could question the one percent prevalence of stuttering adults. While good numbers are not available for every tribe, clan and ethnic group, we can still say something about the prevalence of stuttering is such populations. There is no group in the world in which the prevalence of stuttering is thirty percent. In other words, there is no population in which stuttering is absent, and none is which stuttering is dramatically higher than one percent. We can say with reasonable confidence that if there was a culture in which stuttering was much more common than one percent, we would probably know about it.

So let's take the one percent estimate, and use it as a first approximation test of stuttering hypothesis. Early in the twentieth century, the influence of Freud was strong, and psychoanalytic theory was used to propose that stuttering resulted from oral-sadistic tendencies (whatever that means). We can ask, if it is true that such tendencies develop during early childhood, is it plausible that they occur in one percent of children across dramatically different cultures on different continents? Does that pass the sniff test? Different religions, different family structures and different child-rearing practices would all have to produce this same condition at the same rate. It's hard to imagine that even the confirmed Freudian of the 1920s would actually maintain such a belief when confronted.

We can ask the same question of any behavior-based hypothesis. Whatever causes the behavior - parental disapproval of normal disfluency, mistaken self-judgement of speech competence, etc, Is it plausible that this very specific speech disorder could be produced at the same rate throughout the many different cultures of the world by these methods? If the origin of stuttering were based entirely on environmental causes, why would different environments not produce different results? Do high-income parents in the United States raise more (or fewer) stutterers than working poor parents? Do rural residents produce more stutterers than urban parents? Church-going versus non-believers? Jews versus Baptists? As far as I know, the answer to all these questions is no.

Stuttering has a long history of being the square peg that is pounded into the latest and most fashionable round hole. The rise of Freudian psychology made stuttering the result of a neurosis. Learning theory made stuttering the result of classical, and then operant conditioning. In each case, true believers of new schools of psychology looked at human behavior - including stuttering - through the tinted lenses of of their belief. In a sense, each school of psychology is an ideology. That is, they follow the logic of a single idea. The more aspects of the human condition that can be explained by the theory, the grander it becomes. In many, if not all cases, those taken by the logic of a particular psychological idea seem to have staked a claim to stuttering as their own, without first testing whether their theory was consistant with the knows observations of the condition. If they had done so, decades of wasted effort could have been saved.

Knowing that across cultures, social conditions, place and time, one percent of children become persistent stutterers, it is inconceivable to me that the cause of stuttering could be found in something as variable as parental - or child's own - attitudes. As phrased above, it just doesn't pass the sniff test. In science - indeed, in rational thought - we accept that which is provisionally most likely, and reject what which runs afoul of what we hold certain. With stuttering, this fundamental principle has not been followed. Favored theories have been proposed in sequence, without regard to what are sometimes called "the facts on the ground." Entire careers - and the careers of student/followers - have been built on foundations fatally flawed. The fact that so few people have pointed out these obvious flaws is an indictment of the field as a whole.

Fill in the blanks

2010-03-07T19:05:00.003-05:00

Here's a little test for you. Fill in the blank at the beginning of each sentence. Don't take too long - just come up with something that seems to fit the definition. The result will not count towards your final grade. ;-)

1. ____ is a morbidity of social consciousness, a hypersensitivity of social attitude, a pathological response. 2. ____is the result of conflict between opposed urges to speak and to hold back from speaking. 3. ____ is the disorganization of normally fluent speech that is a consequence of conditioned emotion. 4. ____ is a symptom of an emotionally disturbed personality that profoundly affects the physical, mental and emotional life. 5. ____ is a habit of making elaborate preparations for speech on the assumption that it is a difficult and treacherous process. 6. ____ is an anticipatory, apprehensive, hyptertonic avoidance reaction. 7. ____ is a psycho-neurosis caused by persistence into later life of early pregenital oral nursing, with oral-sadistic and anal-sadistic components. 8. ____ is to speak or say with involuntary pauses, spasms and repetition of sounds and syllables.

Did you guess that the answer to the first definition was stuttering? How about the second? The third? Yep, the answer to all eight definitions is stuttering. The first seven definitions were taken from the following experts in stuttering by Marcel Wingate in his book Foundations of Stuttering: J.H. Fletcher, 1958, J.G. Sheehan, 1953, E. Bruten & G. Shoemaker, 1967, M. Gifford, 1958, O. Bloodstein, 1984, W. Johnson, 1948, I. Coriat, 1958.

The final definition was taken from Webster's New World Dictionary. Now go back and look at those seven definitions generated by "experts" and compare it to the dictionary definition. Doesn't the general-use dictionary make more sense than the expert definitions? Of the expert definitions, one, four, five and six don't even mention speech! Wouldn't you think that a definition of stuttering would at least mention speech, if not, you know, stuttered speech? Numbers two, three and five could refer to any anxiety over speech, such as stage fright. When Marcel Wingate gave this test to his speech pathology class, very few were able to come up with correct answers.

The truth is that these "definitions" excepting the plain-English dictionary offering - are actually efforts to rationalize certain theories of stuttering. All of them are psychological in nature. Some are still popular today. If I could do one thing for stuttering therapy education, I'd make every young prospective therapist get the final, dictionary definition tattooed somewhere on their body. Just so they don't forget, stuttering is stuttering.

Stuttering Technology - 1912

2010-03-05T20:20:00.003-05:00

If anynoe knows how this device was supposed to work its stuttering therapy magic, I'd love to hear about it.

Charles Van Riper on "being willing to stutter."

2010-03-02T00:00:00.001-05:00

Charles Van Riper was probably the most important stuttering therapist of the twentieth century in the United States. His methods have been adopted widely, and his books and other writing were highly influential. A recording of an interview he once gave is available here linked to the words "this interview."

"...these therapists who suggest that stutterers be willing to stutter.... I think that's outrageous. It asks the impossible. On the other hand, you can ask them to study what they're doing, to learn how to change what they're doing, and to find an easier way to respond to the fear of stuttering or to the feel of stuttering. If, when fear comes, he doesn't just panic, but he tackles that word carefully, if a moment of stuttering comes, he finds an easier way out of it, making faces, all of the unnecessary things that he's learned... you can be willing to work, but you can't be willing to stutter, I think. [my emphasis in bold]

Van Riper saw stuttering as an affliction to be confronted and overcome. I find it interesting that some speech therapists today use Van Riper's techniques, which are based on Van Riper's understanding of stuttering, yet seem to be more interested in the confronting and "accepting" than in overcoming.

Marilyn... Meet Winston

2010-02-27T00:01:00.002-05:00

If you are a stutterer, you've seen the lists. Famous stutterers. Actors, singers, politicians and athletes. Here we have two who make every list, Marilyn Monroe and Winston Churchill. I'll leave aside the degree to which the two actually stuttered, and what this should mean to stutterers, and make another point.

Has anyone under the age of 40 actually sat through a Marilyn Monroe movie? The poor thing died in 1962 - I seriously doubt most post-baby-boomers know anything beyond the name and a few iconic photos. And Churchill? I fear that most recent American high school gratuates probably can't say what he's famous for.

If you're going to go the Famous Role Model route - which I see little sense in - I think you need to get off the historical figures bandwagon and find some more contemporary examples. As it is, I find this lists depressing in that with 3 million stutterers in the United States, so very few can be found as role models.

I dunno..... (really?)

2010-02-24T18:15:00.002-05:00

I became familiar with Robert Quesal, Ph.D. through the Stuttertalk.com podcasts. A quick search found his own web site, which linked me to the following article:

The Role of the Stutterer in Therapy

An examination of that article would extend far beyond a single blog post, so I'll start with one sentence.

"When we observe people who stutter, we have no way of knowing, for sure, which disfluencies that we are seeing are "stuttering," and which are the same types of disfluencies that anyone would exhibit."

First, let me point out that Dr Quesal sees the need to put the word stuttering in quotation marks, as if he were adding a parenthetical "so-called". Second, and rather more important, Dr Quesal tells us that as a Ph.D. in speech pathology, and over 25 years experience, he is incapable of recognizing stuttering when he sees and hears it.

Stop and think about that.

Now let's put on our common sense hats. I think it's fair to say that Dr. Quesal knows stuttering when he sees and hears it perfectly well. In fact, I think it's fair to say that you don't need a Ph.D. to recognize stuttering - any person taken off the street could do nearly as well as Dr. Quesal. People either stutter, or they don't. There was no qualification in the quote above for very mild stuttering, or for stuttering we get away with occasionally. The quote begins "When we observe people who stutter..." No qualifier here - this is meant as a statement of general principle.

So why would an "expert" in stuttering say that he can't recognize the fundamental fact of his field when we believe that that statement can't possibly be accurate? An answer, ironically (or not) comes from the late Marcel Wingate, who was paraphrased disapprovingly in the article cited above. Wingate railed against the tendency to obscure the nature of stuttering by some researchers, particularly Wendell Johnson of the University of Iowa.

This obscuring comes about through the introduction of the idea that stuttering is just another form of "disfluency." These days, it's hard to read a paragraph on stuttering without finding the words fluency or disfluency at least once. This focus - or misdirection - on disfluency just serves to take the spotlight off the matter at hand: stuttering.

This confounding of stuttering - a very special speech disruption - with what is called "normal disfluency" is at the heart of the problem. When stuttering becomes not just "stuttering," as it is understood by most people on the planet, but every hesitation, repeated word and slip of the tongue, then the quote above can be twisted into making sense. Yes, people who stutter do hesitate like normal speakers, and that hesitation cannot be separated out from the hesitation of a non-stutterer. So in that sense, the quote follows its own logic.

The problem with the quote above - the reason it fails so dramatically in a common-sense way - is that when Quesal uses the word stuttering, he doesn't mean stuttering. He means stuttering and all that other stuff that is not stuttering, but I'm putting it in the same bag with stuttering.

Wouldn't it make more sense to restrict the word stuttering for when people actually, you know, stutter? Have you ever listened to a person who didn't stutter speak and think to yourself "I wonder if those are stutters, or just stutter-like normal disfluencies?" I haven't. When someone stutters, I know it. When someone doesn't stutter, I know it. I claim no special knowledge, and I certainly don't have a Ph.D. in speech pathology. No one almost-stutters. A stutter is a unique product of speech pathology. It would be nice if experts in the field kept the definition of the essence of the condition to the actual thing itself, and not obscure it by adding a grab-bag of non-essential phenomena.

Stuttering and Social Anxiety Disorder

2010-02-16T22:52:00.003-05:00

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

Stuttering Talk Makes My Head Explode!

2010-02-11T20:57:00.004-05:00

I've taken the following paragraph from Straight Talk on Stuttering, by Lloyd M. Hulit. Please read it, and then I'll comment on it.

"Wendell Johnson popularized what is called the Anticipatory Struggle Hypothesis, which hypothesizes that the stutter stutters because he anticipates that he will have difficulty saying a particular word, and he tries very hard not to fail, as he believes he will. The struggle not to stutter results in the behaviors we recognize as stuttering. In trying to explain why anticipation is not perfect and why some stutterers seem not to anticipate at all, Johnson and others have suggested that anticipation may sometimes operate at a very low level of consciousness. That is, the stutterer might anticipate without being aware that he is anticipating. While this may seem a specious argument to some, I find it convincing. I suspect we have all experienced situations in which we think we are feeling little or no anxiety about something we must do, only to find ourselves relieved when the doing is completed. The relief is evidence of the anxiety we felt, anxiety we did not know we had. I am convinced, based on my own stuttering experiences and on the experiences of my clients, that stutters often anticipate when they are not acutely aware they are anticipating. One only needs to look at the stutterer's face to see signs of anticipation, signs that often appear before words are spoken. Eyes widen. Lips become rigid. Breathing stops. Whether or not the imperfections between anticipations and stuttering can be explained to every one's satisfaction, the Anticipatory Struggle Hypothesis is widely accepted as an explanation for why certain words are stuttered more often that others" (p. 41).

Sometimes, don't you feel like your head is just exploding? I do. Dr Hulit, Ph.D., is a fan of the late Wendell Johnson. In this case, he cites Johnson's proposal for the cause of stuttering. Johnson believed that stuttering wasn't stuttering until parents - and others - called it stuttering. That is, stuttering begins when parents misdiagnose their children's normal disfluency as deviant, thus provoking anxiety in the child, and setting off a chain of results that become persistent adult stuttering as we know it.

Johnson's Anticipatory Struggle Hypothesis, like any such general hypothesis of cause, has to explain all of our observations about the phenomenon. That is, the proposal has to be consistent with what we know for sure - it can't conflict with solid evidence. In this case, all agree that in many cases, stutterers do stutter exactly on words they fear, or when speaking to an authority figure, or when required to speak their names. All of this behavior is consistent with the anticipatory struggle hypothesis - the stutterer knows what is coming, and has opportunity to become anxious, and the anxiety can trigger the stuttering exactly as feared.

It is also known that many stutterers do not stutter when alone, or talking to pets, or in other situations in which there is no performance anxiety to trigger struggle behavior. This, too, supports Johnson's hypothesis. However.... there are problems. As Hultit acknowledges above, there are times when stutterers stutter in spite of no evidence of anticipation. Or as Hulit puts it, anticipation is "not perfect." Hulit cites Johnson and others proposal that "the stutterer might anticipate without being aware that he is anticipating."

This is where my head explodes!

There follows a twisting, backbreaking attempt to save the hypothesis. First, the word "anticipate" is redefined. The conscious experience of anticipation, which is the whole justification for the hypothesis, now works on a subconscious level. No evidence is presented to support such a suggestion, just rhetorical arm-flapping.

"I suspect we have all experienced situations in which we think we are feeling little or no anxiety about something we must do, only to find ourselves relieved when the doing is completed."

Actually, no. I don't know what he's talking about.

"One only needs to look at the stutterer's face to see signs of anticipation, signs that often appear before words are spoken. Eyes widen. Lips become rigid. Breathing stops."

Of course the signs often appear before words are spoken - the poor soul is anticipating - consciously!

"Whether or not the imperfections between anticipations and stuttering can be explained to everyone's satisfaction, the Anticipatory Struggle Hypothesis is widely accepted as an explanation for why certain words are stuttered more often that others"

First, we're not talking about "imperfections," It is a demonstrable fact that stuttering can and does occur when there is no opportunity or evidence for anticipation. Any general hypothesis for stuttering has to account for all the evidence, not just some of it. Second, widely accepted by whom? Is this an appeal to authority? Don't tell me that someone accepts it - prove it to me. Third, now the hypothesis is for why "certain words are stuttered more often that others." When the hell did a general hypothesis for stuttering become limited to "certain words?"

The worst part of the entire effort is this:

"While this may seem a specious argument to some, I find it convincing."

In other words, he knows exactly what he's doing, but he does it anyway. This was the precise point my head exploded. So you know what you're saying has no basis, but you're sticking with it? No doubt, I am not the first to make this point. I'm sure that Hulit acknowledges the obvious flaw in the hypothesis because it was pointed out by other long ago.

When students enter graduate school in the sciences, many are asked to read classic essays on the practice of science. One of these classics warms against falling in love with a favored hypothesis. Instead of developing - or learning - a favored explanation and defending it to the last, you are admonished to always be ready to allow the evidence to change your mind. There's a seductive danger in signing on to a particular hypothesis - once you invest yourself it its truth, it can be very difficult to say those three scary words - I - was - wrong. All evidence against the favored hypothesis is denied or explained away - like non-anticipated anticipation. Luckily for me, every time my head explodes, the pieces return to their proper place and I can return to thinking the next day.

Book Talk - Understanding Stuttering

2010-02-07T20:27:00.002-05:00

As I read to inform myself and gather material, I'd like to pass on my opinion of various books - a sort of a Consumer's Report for stuttering books, if you will. I'll start with Nathan Lavid M.D.'s small book Understanding Stuttering (2003). At 75 pages of text, plus appendix, glossary and bibliography, it's an easy read, and is written for a general audience. Chapters are: 1. Stuttering Defined, 2. Who Stutters, 3. The Biology of Stuttering, 4. Treatments of Stuttering, and 5. Searching for a Cure.

Such a small book has the virtue of getting to the point quickly, and the vice of not always making its point properly. The first two chapters do the job reasonably well for the general reader not familiar with stuttering or the stuttering literature. The third chapter, The Biology of Stuttering does rather well for its size, discussing relevant brain structure and language-generating areas, brain imaging research, pharmacology and genetics.

The fourth chapter, Treatments for Stuttering, is a disappointment. There is a discussion of brain plasticity and the much-discussed factors that induce fluency (choral speech, singing, adaptation, etc), but the only look at actual speech therapy we get is the author's own practice of Cognitive-behavioral therapy. Nothing on fluency shaping, Van Riper's stuttering modification or operant behavioral practice. After four and a half pages, he goes on to pharmacology and examines various drugs that have been used to treat stuttering. Rather a disappointment there.

The final chapter - Searching for a Cure - is all of seven pages long, and offers little of substance.

All in all, I'd rate it worth borrowing from the library - as I did. The content seems to be reliable as written, only suffering for what it lacks. For those with little time or lacking the inclination to dig into the stuttering literature, this would be a good start.

I'll give it Three Stars out of five. Some good content, but not not long enough to cover the topics properly. In the case of the therapy section, entirely unsatisfactory.

To Control or Not to Control.

2010-02-03T19:47:00.005-05:00

Out of Control.

In an earlier entry, I cited the following quote from long-time speech therapist Barbara Dahm: "My firm belief is that people stutter when they are exercising control over speech processes that are meant to function on an automatic mode.” A long and fruitful discussion earlier this week has caused me to revisit this quote sooner than I would have expected. I'd like to suggest that the statement above is not only wrong, as in backwards, but it is inside-out as well, if such a thing is possible.

Let's look at a typical stuttering event. A stutterer says "My name is P-P-P-P-P-........P-P-P-P-P-P-P..... aul." Throughout the rapidly repeated "P" sounds, the speaker has shown tenseness in the facial muscles and an abnormally strong breath exhalation on each "P" effort. One could say that these tense, strained and unnatural efforts are part of the maladaptive "exercising control" that Ms Dahm speaks of above. This is a plausible explanation - let's see if it is the best explanation.

Stuttering is immediately recognized as wrong by the speaker at an early age. The stuttering literature gives many examples of young children straining in self-knowledge at their inability to speak works naturally and effortlessly. Certainly, adults are fully able to recognize their own disfluency, even if sometimes they can block it out.

In the example above, the stutterer begins to say his name, and falls into a stereotypical repeat pattern. We might say, for Ms Dahm (if we understand her correctly) that upon reaching his name, the stutterer has assigned to conscious volition a physical/mental process that can only be accomplished by sub-conscious, non-volitional control systems. Again, this is a plausible proposal. Now, let's look at it from another direction.

I will propose here that something very different has happened. The strain and other non-natural behavior seen in stuttering is not found in fluent, non-stuttered speech, and can be seen as - and may, in fact, sometimes be - volitional. But let's go back to the "stuttering moment" above and read it in a different way. The speaker begins his sentence, reaches his name, sounds the "P" and blocks. He knows from experience that this will lead to a series of repeats - the stereotyped stuttering. If he wanted to "take control," what would he do? He might push harder, in some sense, as stutterers so often do. This just increases the tension and anxiety level, and provides positive feedback to increase the stuttering, as Ms Dahm's model might suggest. Here is where I differ.

To gain control, the stutterer always has another choice. He or she can simply stop. Stopping is the ultimate control. If you don't want to stutter, you can always just stop, rather than falling into the stereotypical stuttering pattern. In the hypothetical sentence above, the speaker could say "My name is P-..... aul," or "My name is P-P-P-..... aul. In either case, as soon as the stuttering event is triggered and started, the speaker recognizes it as soon as possible and simply stops. This form of control would not stop the stuttering impulse from occurring, but it has the capability of lessening the symptom dramatically. So why don't stutterers do it? Why don't they even try to "exercise control" and remove themselves from stereotyped pattern or repeating or prolonging that is experienced as so painful?

So here is my counter-hypothesis to that of Ms Dahm. The stutterer doesn't stutter because he/she seeks to take control of the natural, sub-conscious speaking process; the stutterer stutters - in those stereotypical repeats and prolongations - because he or she instinctively seeks to give up control of the disfluency impulse to the (flawed) natural, automatic process. That is, the stutterer does the counter-intuitive - repeating the same letter-sound over and over, in an unsuccessful attempt to move on to the next sound - because he is under a natural compulsion to let the automatic process do its proper work.

Human speech evolved over hundreds and thousands of generations. We learn language and speech naturally, without any conscious effort of teaching, and without conscious effort on our own part to "learn." Our brains are wired to produce speech like they are wired to produce walking on two legs. Should be be surprised that impulse to speak without conscious effort would be a strong one? Wendell Johnson famously said "Stuttering is what stutterers do when they try not to stutter." Ms Dahm seems to fall comfortably into the Johnson school of stuttering theory.

Let me rephrase Johnson's much-cited quotation to my own liking: "Stuttering is what stutterers do, in spite of the fact that they don't want to do it." From that perspective, we can ask new questions. When stutterers know that their speech follows a pattern of long repeats and prolongations, why do they not take control and stop? It is the longest symptoms that are felt to be the most disruptive, and most noticed by listeners/observers. One might suggest that the stutterer is hoping to get through the dysfluency sooner rather than later. In fact, stutterers themselves may say that very thing. That doesn't stop us from pointing out that after years and literally thousands of failures to get it out "sooner rather than later," that reading of the situation doesn't impress.

The stuttering literature is full of citations of stutterers - and observers - describing a "loss of control" during stuttered speech. Are both stutterers and observers wrong in their interpretation? Let's take another tack on this subject. There are just a few basic schools of stuttering speech therapy today. The mainstream methods seem to agree on their basic approach - they seek to teach the stutterer skills to consciously control his or her speech. Slow speaking, controlled breathing, relaxation.... these are all exercising control. Which, of course, Ms Dahm believes is the cause of the problem in the first place.

Both fluency shaping and stuttering modification require the client to take control of his or her speech production in a careful, conscious way. And, interestingly, those who go through both of these therapy programs sometimes find that the effort to suppress their stuttering through such active control methods grows tiring to the point that they choose to give up the effort and revert to stuttering. How can that be?

If I am right, and stutterers stutter to the degree they do because of a natural impulse to allow speech to function automatically, then both of the above observations make sense. First, it requires conscious control of speech production (as taught in speech therapy) to increase fluency. Second, the impulse to allow the natural, sub-conscious generation of speech is so great that it can overcome an otherwise successful therapy program that relies on taking the speech generation away from its natural source and assigning it to constant, conscious monitoring and modification.

So there you have it. I can't prove I'm right, but my hypothesis is in concert with the observations I've noted above. I would argue that it is superior to the Dahm/Wendell Johnson hypothesis on multiple levels. It's a start.

*** Tip 'o the hat to Jamie R. for helping me clear my thoughts on this matter. All errors, misunderstandings and general BS are mine alone.

Silence of the Stutterers

2010-01-30T21:58:00.003-05:00

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.

Chasing the Fluency God

2010-01-27T13:59:00.003-05:00

Who coined the phrase in the title above - do you know? I'd like to see how it was originally used. It seems to be one of those memes that everyone uses, but no one defines.

If you happen to find this post a year from now (1/27/10) and know the answer, don't hesitate to leave a comment - I'll get notice of it.

*** Here we have a usage from August, 1998. Let's see if we can go back in time from there:

http://www.mnsu.edu/comdis/isad/papers/quesal.html

Nail Head, Meet Hammer

2010-01-24T23:11:00.003-05:00

First, a shout-out to my friend Jamie Rocchio for providing a great topic to discuss. Jamie is a regular guest on the Stuttertalk.com podcasts, and on Episode 172, a little less than half-way through, she raised one of those questions that cuts through the BS and gets right to a critical point regarding stuttering therapy:

“If it’s OK to stutter, then why do I have to change?”

You are welcome to go listen to the podcast and hear both the context of Jamie’s question, and the discussion that ensued. Here, I’m going to take the question as my own and see what I can do with it.

An Internet search of the words “OK to stutter” comes up with a limited number of hits, most using the admonition as advice to children. Such advice can be understood as a reasonable effort to remove the stigma and fear of stuttering from children. In this case, “it’s OK” means that it is not a crisis or a disaster. This is a neutral statement: “It is all right/it is not bad/we will not be angry if you do it.” Giving the stuttering child permission to stutter (which he or she will inevitably do) without self-imposed penalty can only aid in lowering anxiety levels regarding speech performance.

There is, however, another variation on the “OK to stutter” meme. In this case, the statement is a positive one. We could phrase it variously “There’s nothing wrong with stuttering” or “there’s no reason why you should try to stop yourself from stuttering” or even “stuttering is just another way of speaking.” Here, the words are my own, but I’m trying to reflect a “stutter-positive” attitude that is not difficult to find in the stuttering community. As I understood Jamie’s statement quoted above, this is what I heard he to be referring to. The advocacy of open stuttering and voluntary stuttering could hardly exist without my paraphrasing above being reasonably accurate.

This stutter-positive message can easily be supported by reasonable, rational argument. There is, in fact, no reason for stutterers to feel shame or guilt or fear. Those are all self-imposed punishments, and can be removed with reflection and self-examination. While stuttered speech is sub-optimal, it is capable of containing the same information content as speech in the normal/fluent range. Some listeners will respond negatively, but we are all capable of understanding that fact and taking it into account. With sufficient equanimity, we can humor the less-than-sympathetic listener and pity those who are hostile.

Given the above, and given that such stutter-positive messages come from speech therapists as part of their understanding of the nature of stuttering and the condition of the stutterer in society, I could reword my friend Jamie’s question above to direct it towards the speech therapist thusly: If stuttering is OK, then what am I paying you for? If the therapist - as opposed to the stutterer - believes that stuttering is OK in a positive sense, then the need for speech therapy, as opposed to psycho-therapy - goes out the window.

In order to deal with the baggage of years of stuttered speech, a person needs to shed the negativity that has encrusted them like barnacles on a ship’s hull. The fact that those negative feelings can be reinforced every time we speak means that we have to both give up the memory of old fears and stop the generation of new ones. If we understand our stuttering as sub-optimal speech performance rather than a moral or personal failure, then we can be free to engage in speech therapy (speech performance improvement) without the negative secondary feedback of performance anxiety. If, on the other hand, we take literally the admonition that stuttering is OK - as in there’s no reason we should wish to not do it - then this reasonable, rational admonition does raise what we might call the happy-stuttering speech therapist’s dilemma: If I really believe this, why don’t I just send them to a psychologist to deal with their negative emotions and let them stutter in peace?

This is the question I understood Jamie to be asking on the Stuttertalk podcast, and the question never did get answered. We can imagine an answer that squares the happy-stuttering circle, but it requires one say “When I say it’s OK to stutter, I don’t mean….” This is a complex subject, and simple admonitions don’t lend themselves to subtle distinctions. The problem is two-fold. Sometimes, we hold conflicting positions that lead us into logical dilemmas when examined (stuttering is OK: there is value in speech improvement therapy). On the other hand, our way out of the dilemma may be to accept that we really don’t mean what we say.

Note: All interpretations of statements made on the Stuttertalk podcast are my own. I have taken a quote from the podcast for my own purposes. To hear Jamie and Eric discuss the topic in their own words, please go here:

Stuttertalk

The Pill Question

2010-01-18T06:00:00.000-05:00

It seems to be popular in the stuttering community to ask the question "If there was a pill that cured stuttering, would you take it." Sometimes, I imagine it's used simply as a conversation starter among stutterers shy about talking. I have the sneaking suspicion that it may also be used by speech therapists in a counter-intuitive manner to suggest to stutterers that they should see positive sides to their stuttering.

Since the question seems to be a bit of a cliche now, I'd like to rephrase it to start a new discussion, and make a different point.

If there was a pill that caused life-long, incurable stuttering, do you think that non-stutterers would take it?

Ahhh... that's different, isn't it? Compare and contrast the two questions.

Killed By An Ugly Fact

2010-01-14T18:34:00.004-05:00

[Addendum: I've just found a very interesting blog by Silvano Columbano that collects entries from the STUTT-L list during the 1990s. I'll add a link to the blog, but specifically relevant to the topic of this entry is this post.]

One of the basic tests of a scientific theory is whether it explains observations of the subject of interest. Or, turning that around, is there anything we know about the subject that conflicts with the theory? There’s a famous saying in science regarding a beautiful theory being killed by an ugly fact. It appears from a casual reading in the world of stuttering that those who propose theories are not constrained by such unfortunate facts.

Barbara Dahm is a well-known name in speech therapy, and .is the founder and Director of CTI Communication Therapy Institute. After working as a speech therapist for many years, she developed her own therapy program: Generating Fluent Speech: A Comprehensive Speech Processing Approach.

In a short article reprinted in the book Stuttering: Science, Therapy and Practice, Ms Dahm describes here education, from graduate school through the study of Gestalt psychology, to training in the Precision Fluency Shaping Program. Finally, after working with clients and feeling unsatisfied with fluency shaping, she developed her own Comprehensive Speech Processing Therapy (yes, these programs are apparently all worthy of capitalization).

Ms Dahm‘s therapy program is based on an insight she had when working with stutterers. She states: “My firm belief is that people stutter when they are exercising control over speech processes that are meant to function on an automatic mode.” Hmmm…. let’s think about that. She doesn’t say that some people stutter, or people stutter some times; she makes a general statement that stuttering occurs when there is active control over the speech effort, rather than the natural, un-self-conscious process present in non-stutterers. This brings to mind the classic parable of the centipede, who loses his ability to walk when he stops and thinks about the necessary coordination and movement of all his one hundred legs.

In order to make sure I’m not taking the above quote out of context, lets look at another:

“During the Generating Fluent Speech program, people who stutter relearn the speech production process. While doing the various exercises, they learn to vibrate their vocal folds in an easy effortless manner that eliminates the feeling that they do not have enough air to speak. They learn that it is not only not necessary, but, actually, debilitating to monitor words and speech sounds. The Generating Fluent Speech exercises help them to move their focus of attention away from this activity. As a result their language development process is simplified and becomes subconscious. In addition, they learn to give up control of their speech muscles. Articulation becomes an automatic process that works efficiently at a rapid rate.” (My emphasis added).

I think it’s fair to take from the above quotes the assumption that it is the attempt to consciously monitor and control the speaking process that causes stuttering behavior. Like the poor centipede who tries to consciously coordinate all one hundred legs and becomes paralyzed by the complexity, so the stutterer tries and fails to monitor and consciously control the highly complex process of speech production.

Assuming I’ve been fair in interpreting the above quotes, let’s stop and think about this. At the beginning of this article, I said that one of the basic tests of a scientific theory is whether it explains observations. Here, the claim is that stuttering occurs when the speaker is “exercising control over speech processes that are meant to function on an automatic mode.” Are there any observations that conflict with this assertion?

Ask yourself, does stuttering only occur when the speaker has had an opportunity to assert conscious control over his or her speech? Or turn the question around and ask “Does stuttering behavior ever occur when there has been no opportunity for conscious control of the speech process?” More simply, does stuttering ever occur without warning? To me, the question is rhetorical - because the answer is so obvious.

With the exception of the most extreme cases, stuttering is defined by its episodic occurrence Although there are situations in which stuttering behavior can be expected - and might fit the theory, at least in part - most stutterers encounter blocking without warning as well. We can stutter when we are with family, when we are relaxing, or in the middle of an otherwise fluent sentence. Any observation of stuttering behavior over time would reveal many such examples. Self-consciousness may aggravate stuttering frequency or severity, but self-consciousness is not synonymous with conscious control of the speaking process.

We can look at this question from another angle. If the hijacking of the automatic speech process by conscious effort produces stuttering, then shouldn’t we expect people who are asked to speak with conscious control to stutter? Does an actor stutter when learning his or her lines? In fact, stutterers have been known to gain total fluency by speaking with a special accent. For the average American, much less and American stutterer, speaking with a fake accent would surely require constant monitoring and control. How does Ms Dahn’s theory of stuttering explain this observation?

When children are asked to read aloud in class, they are in a situation that restrains natural speech and requires much more control than conversational speaking. Does reading aloud in school produce stuttering? I am not familiar with the scientific literature, but I have never heard such an assertion.

We are left with observations of stuttering that conflict directly with the theory proposed by Ms Dahm. I am confident that the disparities between theory and observation are so great that the theory must be rejected. So what does that say about Ms Dahm’s work in stuttering therapy? Perhaps, not much. Perhaps she is successful as she claims to be. How do we explain this?

It could be that her therapeutic methods work - when they do - for reasons divorced from her understanding of the justification for them. You might say that she is doing something right for the wrong reason. In the end, her correct methods work in spite of her theoretical understanding, not because of it. Another possibility is that her success comes less from her method than from a generalized therapeutic effect. That is, all that work on speech and support from instructors makes the client feel like they are doing something valuable, and so they gain benefit. This would help explain why different therapy programs, with very different theoretical underpinnings, report similar success rates. It may be that it’s less important what you do than that fact that you’re doing something.

The point of the article is to show that a person who has worked professionally for decades, and has developed their own stuttering therapy method, can miss an observation that has been staring them in the face for years. Conscious effort does not cause stuttering - stuttering causes conscious effort, which may aggravate stuttering frequency and severity. To understand the causes of stuttering, and to provide the best possible therapy, at a minimum you have to get the direction of cause and effect correct. Pain and a limp do not cause a ruptured disk in the back, and conscious speaking effort does not cause stuttering.

Sources:

Generating Fluent Speech: A Comprehensive Speech Processing Approach

Stuttering: Science, Therapy and Practice, by Thomas David Kehoe.

Stuttering As Hunt-And-Peck Speech

2010-01-11T14:51:00.004-05:00

Thomas David Kehoe is the author of the book Stuttering: Science, Therapy and Practice, subtitled The Most Complete Book About Stuttering. The book runs over 300 pages, and covers research, therapy and practical advice for stutterers. The book provides both an overview of stuttering topics and Kehoe’s commentary and personal beliefs. I’d like to comment on one particular point that the author makes, based on his own understanding of the nature of stuttering.

In the chapter Motor Learning Theory, Kehoe makes a distinction between bad habits and maladaptive motor skills. He does this through an analogy with typing. Kehoe is a four-finger typist, which limits his typing speed, but to significantly improve his speed, he would have to learn touch typing properly from the beginning, and temporarily type very slowly while learning proper technique. He goes on “Stutterers can talk, but not as well as they could if they had learned to speak fluently when they were children.” Later in the book, he says .“Stutterers can talk, but not as well as they could if they had learned to speak fluently when they were children.”

This is where my head explodes. We learn to stutter analogously to the way we learn typing? It boggles the mind. Is there something about stuttering that fogs people’s minds? And this from a stutterer.

Where do I start? Stuttering is not a maladaptive, suboptimal motor skill. To the degree that stuttering requires a particular set of motor skills, those skills are insignificant byproducts of the stuttering impulse. Stuttering is not a motor skill, it is the intermittent loss of normal speech motor skill.

As children, stutterers certainly learn maladaptive behaviors. Stutterers learn to increase tension in their speech muscles, to fidget and to lose eye contact. Those behaviors are not part of normal speaking, subtract from normal communication, and feed back to increase stuttering severity. They are not, however, essential parts of the primary stuttering impulse or behavior. Those secondary elements of stuttering can be stripped away entirely, but the primary stuttering impulse and behavior will remain - which is just an observation of the notorious persistence of stuttering.

Four-finger typing is sub-optimal because it does not take advantage of all available fingers, as intended by the keyboard. It is not sub-optimal because sudden cramps in the hands cause four rather than eight fingers to be used. Any hunt-and-peck typist can learn to touch type with sufficient effort. Would that it was so for stutterers. Human children are wired to learn speech, without conscious teaching or effort - it comes naturally, like songs in birds. Stutterers are not people who fell into poor technique as children. Stutterers encounter interruption of proper technique, recognize the failure of their natural speech, and respond the only ways they can - sometimes maladaptively - as children.

Typists can be taught a new method of typing by simply dropping the old method entirely and replacing it with a new one. The maladaptive behaviors of stuttering can be pointed out and removed from a stutterers’ speech - with great effort - but replacement of all stuttering with fluent, natural speech is another matter entirely. Unlike typing, stuttering comes with the impulse to stutter, which is notoriously resistant to suppression by simple motor practice. The neurological impulse, which was never part of the behavior, is not dealt with directly by speech practice.

Speech therapy can certainly decrease stuttering disfluency in many people, typically by slowing down and otherwise altering speech to the point that it is volitional - and disfluent, in a controlled way, by rate, rather than in an uncontrolled way by interruption and repetition. Kehoe claims that fluency can, in fact, be reached and retained by such practice, but then says that most stutterers just won't stuck with the process long enough to be successful. I would suggest that his misunderstanding of the nature of stuttering is a better explanation for the lack of truly fluent, natural speech success stories than his behavioral model of stuttering.

The more I read, the more I wonder: is there something about stuttering that causes fuzzy thinking?

I'll add that this is not a book review, and the book has plenty of good information in it. This one analogy - which Kehoe uses to justify his therapy beliefs, just stuck out like a sore thumb. Or typing finger.

Easy For You To Say

2010-01-09T18:13:00.003-05:00

Many years ago - perhaps around 1980 - I read an article or a book about stuttering that contained a claim that stayed with me for some reason. It wasn’t particularly noteworthy to me at the time, but it buried into my memory and stayed available until now. The writer proposed a problem in the stuttering community. I don’t recall his exact words, but to paraphrase, he said that there was a problem with mild stutterers giving advice to more severe stutterers.

Here, I’ll describe the problem he saw (as I remember it), and comment and elaborate on it as I go along. He described a situation in which people with a relatively mild case of stuttering set up a local self-help group. It takes a certain amount of confidence to do so, so we shouldn’t be surprised that a person who has a relatively mild stutter would be the one to do so. Notices go up, maybe a listing in the local newspaper, and a few brave stutterers show up for the first meeting.

As the founder of the group, and already having a reasonable degree of fluency, our mild stutterer becomes the leader of the group. We can imagine that other members with a more severe condition might hang back, happy to be in the group, but still not willing to do a lot of talking.

So time goes by, they meet each month, and gradually the leader - and any other mild stutterer in the group - start to get confident in their speech in front of the group. After all, in the land of severe stutterers, they actually become the (relatively) fluent ones. The group gives them practice speaking in front of an audience, and to get long pent-up frustrations off their chest. For these mild stutterers, the group is truly therapeutic.

Time passes, the mild stutterers keep benefiting, while the more severe stutterers gain a sense of community, but little else. It’s nice to make friends and share stories with other stutterers, but they still tend to hang back and let the more fluent do much of the talking. Their speech in front of the group changes little, and any benefit goes away when they leave the meeting room.

Finally, the leader and the other mild stutterers decide that they’ve derived all the benefit they can from the group, so they decide to leave it and use their new-found confidence in their every-day lives. Which leaves the more severe stutterers to themselves. Now, with the more fluent and talkative stutterers gone, no one picks up the leadership, the group becomes less positive and affirming, and it gradually breaks up.

So those whose speech could be expected to benefit the most have harvested the benefit and moved on, and those most in need have been left behind with little to show. Unfortunately, I can’t cite the author of the above, much-paraphrased story, but that was the gist of it as I remember. If it sounds familiar to anyone, I’d love to hear from you.

I can’t vouch for the validity of the story, but it certainly made sense me, enough to remember it after all these years. It’s hard to imagine anyone making it up, so let’s go with it and assume it has some factual basis. I think it’s reasonable to say that in any self-help, self-improvement group, there’s a point where people feel like they’ve gotten all the benefit from the group they can, and they move on. In this case, we have a situation in which one group - the mild stutterers - are capable of improvement to the degree that they no longer feel the need for therapy of any kind. They were relatively (to severe stutterers) fluent already, and by simply adding experience with public speaking and a degree of confidence they become ready to face the world. The other group - the more severe and persistent stutterers - began far from fluent, and any benefits they could gain from the group meetings leave them still far from confident and far from fluent. And disappointed at being “left behind.”

This brings up back to the dynamics of the group itself. It’s natural in such a group for members to share experiences and problems and advice. If it was a writer’s group, we could imagine the sharing of methods to get past writer’s block. For stutterers, it would be natural to talk about how each member understands the nature of stuttering - nature of nurture, perhaps - and to discuss any methods they’ve used to gain more fluency.

Here, we run into the original problem posed by the author. Who is more likely to consider themselves a role model for relatively severe stutterers than another stutterer with greater fluency? Even a stutterer with little disfluency can be expected to remember severe blocks and terrible anxiety during their younger years. When severe stutterers discuss their frustration and pain, it can all be perfectly familiar to the now-mild stutterer. So why shouldn’t such a person want to help a fellow sufferer and pass on advice to them?

The question this brings up in my mind is, to what degree are the experiences of the mild, improving stutterer and the severe, persistent stutterer the same? They obviously differ quantitatively, in terms of blocks per 100 words, or repeats per word. Might the conditions also differ in quality? Is it sufficient to speak of mild and severe stutterers as simply variations along a continuum, or is the degree of difference so great that some fundamental differences are lost by thinking in terms of degree? And if we do see a fundamental difference between mild and severe stutterers, should severe stutterers be listening to mild stutterers for advice?

The problem of the mild stutterer giving advice to the severe stutterer was proposed in a general sense by the author whose article I read those many years ago. I assume he was referring to personal experience in self-help groups, but let’s take the principle and see if we can generalize it in another direction.

Since at least Van Riper, speech therapy has attracted stutterers to the field. What could be more reasonable than victims of the condition wanting to help others who share their experience? And indeed, it seems as if there are many stuttering speech therapists out there today, both senior practitioners and newly graduating students. If so, we could apply the implications of my earlier speculation and ask: could speech pathologists who stutter be relying on their own experiences and mis-applying them to the cases of stutterers whose conditions are quite different from their own?

Time to take a step back. What is the case for stutterers working as speech pathologists? One can imagine a parent asking a speech pathologist “If you stutter, how can you help my child?” ”Physician, heal thyself” comes to mind. Of course, our stuttering speech pathologist has the obvious retort: “Who knows better than a stutterer the experience and the needs of a stutterer?” Quite so! A non-stuttering speech pathologist can learn the best practice for therapy, and can be full of empathy, but he or she can never know the experience of stuttering on a subjective level. The testimony of stutterers can communicate the facts, but cannot pass on the visceral experience of stuttering.

So here is the benefit of the stuttering speech pathologist. But if we go back to the content of the previous paragraph, we can probe further and ask: if stuttering speech pathologists are using their subjective experience when seeking to understand the condition and working with clients - and it’s hard to imagine them not doing so - then if their condition actually differs in some important, qualitative way from some stutterers (less, as opposed to more severe, perhaps), then could their own subjective experience be causing them to misunderstand the condition in a particular client?

The non-stuttering therapist lacks the subjective knowledge of stuttering. They may simply not get it. Then again, they also lack the stutterer’s confidence that they understand the phenomenon on a personal level. Thus, they can’t suffer from incorrectly generalizing their own subjective experience to their clients. In the best case, a non-stuttering therapist would come to the condition with an open mind, and remain open to new evidence and analysis.

So let’s go back to the beginning, and ask some questions. Does it make sense that mild and severe stuttering could be qualitatively different in such a way that stutterers from opposite ends of the continuous spectrum are significantly different in some way(s)? It is possible that those hypothetical differences could cause stutterers to mistakenly generalize their own experiences to others? And if so, could the advice - or even simply self-reporting - given by mild stutterers, in either self-help groups or in clinical practice, be doing a dis-service to more severe stutterers?

I dunno - I’m just asking.

Does Stuttering Attract the Best Minds?

2010-01-03T19:47:00.000-05:00

Being safely free of any evidence in this matter, I feel free to ask the question. This is an issue I’ve been wondering about for a long time. Stuttering comes with multiple burdens for the success-oriented student looking for a field to enter. The condition is notorious for its persistence, and few people wants to spend their lives fighting losing battles, or gaining small successes at best. Young researchers are taught to choose topics that lend themselves to successful study results, and, most importantly, paper publication. And in science and medicine, everyone follows the money. Stuttering neither kills nor shortens one’s lifespan. There are no purple-for-stuttering ribbons, and there are no Walks Against Stuttering or telethons to raise private funds for research or treatment.

It is easy to understand how a lack or resources would restrict the ability of researchers to make breakthroughs. The disincentive to enter the field in the first place is a more subtle matter. Some fields loose their attraction after they’ve matured and the Big Problems of the past have been largely solved. Others never attract the best minds because no one seems to make their name in them. Funding agencies look for the best bang for their bucks, constantly looking for the next big breakthrough, and researchers follow the money

We could ask whether the inherent difficulty of the stuttering problem itself is sufficient to explain the lack of advancement in the field, or whether a lack of resources is to blame. Phrased in another way: is stuttering really more difficult to study successfully than other subjects, or is it just a lesser priority than other, equally difficult subjects?

The truth is that not all fields and sub-fields of science attract the same quality thinkers and workers. A comparison of GRE scores (graduate school entrance exams) would reveal a range of averages, with the highly mathematical fields at one end, and the less rigorous, “soft” fields at the other. And within a broad field, the best, most ambitious researchers, professors, post-doctoral researchers and graduate students will gravitate towards work that produces regular, if incremental success, scientific publications in prestigious journals, and professional advancement. Research topics that do not provide such possibilities can become orphan fields, with little money, advance or prestige available. This does not mean that no work gets done - it simply leads to pedestrian research and i-dotting and t-crossing-results rather than dramatic breakthroughs.

One could ask the same question regarding speech therapy. Every therapeutic failure of the past has had its advocates, and many have been licensed professionals and graduates of, no doubt, the best speech pathology programs. I’ve seen multiple discussions of evidence-based speech therapy, but are researchers and therapists properly trained to examine the evidence? The truth of medical research is that many published studies are garbage, plain and simple. They follow the form of the scientific method at a surface level, but they lack the rigor needed to truly answer the question raised. Are speech therapists sufficiently prepared in experimental design and analysis to make sense of the literature of their field? In the same way, we can ask whether they are prepared to analyze their own clinical experiences in a rigorous way. Rigorous critical thinking does not come naturally; it needs to be learned by example and by practice. It is cruel; constantly searching for flaws and questioning assumptions. Does speech pathology education produce such thinkers, or does it produce (hopefully empathetic) speech firemen/women, too busy putting out clinical fires to challenge their own training?

One question has evolved into multiple questions. And all of the latter questions refer us back to the former. What would happen if the best minds in computer science, medicine and physics turned their attention to stuttering? What if the world’s top neurologists and brain researchers took on this topic as their life’s work? And what if Bill Gates dropped one hundred million dollars on funding university chairs, laboratories and clinical researchers dedicated to stuttering? Would it matter, or is the money and effort best used elsewhere? I don’t know, but I suspect that the field could desperately use the kind of brain-power such an effort would bring. No offence to current practitioners, buy the difference between very good and great can be the difference between failure and success.

After Francis Crick teamed with James Watson to discover the structure of DNA during the 1950s, he went on to team with others and perform a series of experiments to determine the genetic code. Molecular biologists still teach from the resulting journal papers, and describe the work as elegant and beautiful. Who today is doing elegant studies of stuttering? Whose work is so tightly constructed that it can rule out all competing hypothesis? It would be wonderful to learn that they are already out there in a lab somewhere. Maybe they are.

A New Year, a New Blog

2010-01-03T19:40:00.000-05:00

One more time, I take advantage of Google's generosity to create a new blog. Or rather, use their free blog offer to create a new web site. This will be less a blog than a place to publish my thoughts on stuttering as they occur to me. My only qualifications are that I'm a life-long stutterer, and I've got a bad attitude. Which will mean, more often than not, that I'll be using this opportunity to challenge what I find elsewhere, whether it's in books or on the internets.

So feel free to comment and criticize - I welcome people who make me think, and I'm not thin-skinned.