Incidental Writing on Stuttering
Darrell M. Dodge
|The essays, reviews, and opinions collected here are
taken from several years of my incidental writing about stuttering. Because stuttering is a behavior that is both inherited and
learned to varying extents, any exploration of its etiology and treatment must look at
aspects of being that are fundamental to the human condition. Many common behavior
disorders (low self-esteem, lack of spontaneity, operational paranoia, excessive
projection or jealousy, etc.) make the mass of humanity miserable, but can often be hidden
from others or the self for a lifetime, even though there may be obvious physical
manifestations (for example, awkward posture or movement, inability to maintain
relationships, etc.). These disorders can even be considered "normal." by many.
Stuttering, on the other hand, is a public disorder, the severity of which is demonstrably
increased by any attempts to hide it. Failure to address this disorder in one way or
another has a profound negative impact on the quality of life of the person who stutters.
Most of these pieces appeared in the newsletter of the Denver Chapter of the National Stuttering Project and/or the listserv Stutt-L. I am indebted to Judith Kuster, who expressed an interest in linking to one of these articles from the Stuttering Home Page, who inspired me to post the others here as well.
Stuttering and Science, William H. Perkins, Singular Publishing Group, San Diego, 1996 ($29.00 from the publisher at 4284 41st Street, San Diego, CA 92105, 800-521-8545 phone, 619-563-9008 fax)
New books on stuttering are so rare that each one is an event. This one is no exception. William Perkins is Professor Emeritus at the University of Southern California. He is not a stutterer, but his book reveals that he has spent a great deal of time trying to feel and think like one.
Perkins' belief is that the reason a cause of (and a reliable cure for) stuttering hasn't been found is that the scientific method has not been used rigorously enough in the search. Whether or not one is convinced of this, Perkins' review of stuttering therapy approaches and their scientific failings, and his discussion of the nature and causes of stuttering provide some rich food for thought. One of his major contributions here is a new point-of-view regarding the method for distinguishing stuttered versus non-stuttered speech, which has bedeviled researchers for some time. He defines stuttering as "the experience of losing control of the speech mechanism," and goes on to place his trust in the stutterer--rather than the non-stuttering observer--to determine when the subject has stuttered. Perhaps just as importantly, he points out that stuttering can only be understood at the level of the individual, rather than in the aggregate. In other words, he suggests that to find a cause (or causes) of stuttering, one must look at individual stutterers first and draw broad conclusions only after many individuals have been studied. This is particularly important for treatment, where the therapist and the client must begin to understand how the stuttering mechanism operates in the individual before there is a real hope of making progress.
To assist in developing new hypotheses with which to challenge current researchers, Perkins places people who stutter into two broad categories, based on his own experience as a therapist for hundreds of stutterers: 1)"transient stutterers" who primarily seem to have trouble initiating syllables, and 2) "chronic stutterers" who experience fluency breakdowns in the middle of syllables.
While Perkins is adept at setting forth the rationale for both genetic and psychological (or environmental) causes of stuttering, his hypotheses come down on the side of those who think that the cause of stuttering is primarily psychological. While I don't particularly buy this [I think it's a combination of nature/nurture that can vary from individual to individual], Perkins does provide a good sample of the rationale for this view. It is all the more telling when Perkins provides some anecdotal "evidence" for this view which clearly demonstrates his subjectivity, as when he interprets a talkative stutterer's domination of conversations as proof that his stuttering is a "covert means of being assertive;" which could be a fine case of projection on Perkins' part.
His most controversial hypothesis is that a predisposition to stuttering requires an experience of helpless terror in early childhood related to the sound of one's voice (specifically, being habitually ignored while crying.) This seems to overlook the possibility that a feeling of helplessness could come from the very act of stuttering in early childhood. Not to mention the potential needless pain this theory could cause to parents of people who stutter if it is not true.
Perkins' compassion and respect for people who stutter is evident throughout this book and, together with the air of open inquiry he provides, makes it easier to keep an open mind about even those hypotheses with which one may be somewhat skeptical.
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(STUTT-L, November 1995)
I've been reading with some interest the discussion of "programming" versus "hardware" and continue to be amazed at the stubbornness of these polarities. I can only say that if stuttering was caused or influenced only by nature or by nurture, it would be the *only* human activity that is. I can only conclude that this is primarily an emotional issue. Some people react to the idea that they might have been born with imperfect "hardware" and rationalize toward the environmental side. Others react to the idea that their minds are creating the entire problem (and that they are thus somehow responsible for it) and rationalize that it must be caused by something organic. Then, there are others, like me, who react to *both* of those ideas and can't figure out *what* to blame it on! (That's only partly a joke.)
Note that all of these are identifications of stuttering with the "self" in one way or another. And that it's physically, mentally and metaphysically impossible for stuttering to be anyone's "self."
I've also been sporadically reading the new book Emotional Intelligence, by Daniel Goleman, (Bantam Books, 1995) which includes an interesting review of recent brain research and a challenging point of view, which I've been thinking about in relation to my speech. I think there's a huge field of work related to the role of the limbic brain, the amygdala, and learned responses to the trauma of childhood stuttering in the maintenance of secondary adult stuttering. I'm aware of the work by Gerald Maguire, but he seems to be concentrating on drug therapy, which isn't particularly attractive to me and--apparently--many other PWS. He also seems primarily interested in motor control aspects of stuttering (the "hardware" part) and--in the January 1995 Letting GO interview, for example--only mentions the limbic brain (which is associated with emotions) in passing.
The amygdala is a bundle of neurons surrounding the brain stem. Recent research cited by Goleman has shown that it plays a central role in transmitting fear and other emotional survival responses directly to the neocortex. The amygdala's evolutionary benefit would be that it enables the person to react even before a threat or other stimulous is perceived. This short-circuits the equivocation that can be present in conscious thought and that would inhibit instant action. Unfortunately, it also participates in the "emotional hijacking" that can lead to uncontrolled outbursts of anger, crimes of passion, emotional "flooding" and other disastrous human activities. Because of this role in fear and "flight or fight" responses, I suspect that the amygdala might also play an important part in secondary stuttering, which would help explain the valid subjective experience that we PWS have that this behavior is caused by something beyond our conscious control. The speed of the response would help to explain how blocks can occur "out of the blue" without any apparent stimulous and would help explain the persistence of stuttering behavior. The amygdala is apparently quicker than the eye and can respond to stimuli of which the conscious mind is not even aware. The would help explain the conscious feeling that one is going to stutter, perhaps partly in response to an inappropriate posturing or articulatory tension that has already been set up.
It seems to me that the amygdala is a logical origin for the reflexive impulse to monitor, "hold back" or "control" speech so as not to stutter, in response to early childhood or continuing speech frustrations (which may or may not be "core" stuttering.) This "hijacking" of the neuro-motor controls could aggravate the laryngeal lockups and create the rigid, inappropriate articulatory postures that inevitably--through gradually increasing covert repairs--lead to severe secondary stuttering blocks. The approach-avoidance behavior associated with stuttering would be eventually be generated by the feedback from predicted stuttering behavior.
Think of the instant feedback that stuttering provides this system! Suppose you have a fluent fellow who reacts to authority figures with fear because of a childhood trauma associated with his father. Everytime he sees his boss he gets nervous and he breaks into a sweat. But his boss is not his dad and isn't going to hit or yell at him. So, as long as he can please his boss, the fellow gets to gradually learn that he doesn't have to be afraid and that his projections may not be reality. Now think of the stutterer. He's afraid of his boss because he's afraid of stuttering in front of him *and* maybe because of other things. And he actually stutters at least a few times every time he talks to his boss because of how much he's trying to be fluent. It's obviously going to be a little tougher for him to unlearn that childhood "programming" (if you will) because it's continually being reinforced and there's an extra layer of reaction.
The other part of this is post traumatic shock disorder (PTSD.) I've thought for some time that a low-grade PTSD plays a central role in providing the energy required to maintain secondary stuttering and have written about this dynamic several times. The amygdala is apparently the receptor of the "learning" that takes place when humans are exposed to physical or emotional trauma. The primary characteristic of PTSD that is relevant to stuttering is that, to register as trauma, experiences must involve a loss of control or a feeling of helplessness. There are few human experiences that involve more of a feeling of control loss and helplessness than childhood stuttering. We all have our own collection of horrors here. I think it's unlikely that these bizarre experiences could go by without having a profound conscious and subconscious impact on us. Models of stuttering that overlook this aspect of the disorder just don't have any credibility with me. I think the "Hexagon" recognizes all of this quite well, of course.
Putting this together, I'll quote two paragraphs from "EI" that speak to the persistence of impulses from the amygdala (and, if I'm on track, the persistence of stuttering, bearing in mind that the reaction to it *continues* to be reinforced until the PWS becomes desensitized to his/her stuttering):
"The dynamic between the amygdala and the more fully informed reactions of the prefrontal cortex may offer a neuroanatomical model for how psychotherapy reshapes deep, maladaptive emotional patterns. As Joseph LeDoux, the neuroscientist who discovered the amygdala's hair-trigger role in emotional outbursts, conjectures, 'Once your emotional system learns something, it seems you never let it go. What therapy does is teach you to control it--it teaches your neocortex how to inhibit your amygdala. The propensity to act is suppressed, while your basic emotion about it remains in a subdued form.'"
and . . .
"Given the brain architecture that underlies emotional relearning, what seems to remain, even after successful psychotherapy, is a vestigial reaction, a remnant of the original sensitivity or fear at the root of a troubling emotional pattern. The prefrontal cortex can refine or put the brakes on the amygdala's impulse to rampage, but cannot keep it from reacting in the first place. . . Over the course of therapy, what seems to change in the main are the responses that people make once an emotional reaction is triggered--but the tendency for the reaction to be triggered in the first place does not disappear entirely."
I think that this would be a very fruitful area for study and experimental research and could provide some clues to stuttering behavior and opportunities for increased consciousness and fluency. Of course, I've had a degree of success with stuttering modification therapy combined with inner emotional/cognitive work. I think the physical component of stuttering needs to be directly addressed with speech modification work of some kind while the psychological and spiritual work is going on. I do notice that trying to focus on the effect of the emotional impulses--as I've consciously done during my practice sessions for a few days now--doesn't exactly do wonders for fluency. It seems as if the reaction is just that much more severe.
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I used to think (erroneously, I might add) that all people who stutter exhibit one fairly predictable "personality." I've come to see that there are as many ways of adapting one's personality to stuttering as there are types of personalities. There are some fairly predictable ingredients though: a strong streak of perfectionism, sensitivity to criticism, an inordinate need to please people, and a strong tendency to react. All these are not so bad as the really yucky tendencies: avoidance, procrastination, passivity, fearfulness, etc. These are so unpleasant for some people that they develop compulsive behaviors to overcome them: hyperactivity, obsessive "do-ism," a need to overcompensate by taking on speech challenges that most fluent people would avoid.
I think it's important for people who stutter to become aware of when a strong desire to confront stuttering begins shading over into these compulsive compensative behaviors, which then begin to feed into one's own secondary stuttering personality. This point is different for different people and no one else can do this for you.
The inner critic (or superego) is a clever character who can become dangerous if left unchallenged. If you're feeling bad about yourself lately, take stock of what you're really doing. Maybe the reason your latest shameful failure (putting off making a phone call, etc.) made you less fluent for a while is that your self-esteen took a dive because you were beating yourself up so badly for it (despite all those other speaking challenges you handled today). Tell your critic to take a hike. And maybe that call will be easier to make when you do get around to it.
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One theme that seems to keep coming up in all systems of personal growth (such as 12-step programs, various types of therapy, or spiritual development) is that "stuckness" and failure is tied to a cycle with three components: 1) want or desire, 2) a continual hopefulness, and 3) a rejection of the present state. "Success", on the other hand, is achieved through a loss of desire, a loss of hope, and acceptance. Thus, Scott Peck begins his most inspiring book not with a ringing note of optimism, but with the leaden and hopeless phrase "Life is difficult."
How easy it sounds. How difficult to achieve. When I look inside myself and inquire into my thoughts, is there a desire to be fluent? is there the hope that I can be "block free"? is there the least bit of a rejection of my stuttering? Of course there is! And yet, these are things I have to work on if I am to progress. It's not enough to accept myself. If I accept my old hope to be totally fluent, that is a hope that keeps me from reality because no one who once stuttered can be totally fluent. (I fritter away my wealth on an impossible lottery, letting my life crumble around me.) If I accept my continual desire to be fluent, I accept my old habits of avoiding stuttering at all costs. (I become fearful of risks: an invisible force turns my jaw into a spring-loaded trap that's out of my control.) Acceptance is important, but it's just the beginning.
Hope is the linchpin that keeps this cycle going. The opposite of hope is not the "hopelessness" with which I'm most familiar--the "oh woe is me" type of wallowing that's based on contrasting what is with what I hope for or what I fear. The hopelessness called for is a clear vision of what is here now. It's simply facing reality--without looking to the past or to the future. It's simple. But it's also difficult. It's the path to the fluency I am capable of achieving, as opposed to the effortless and magical ideal that holds me back.
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(STUTT-L, November 1995)
This question of acceptance of stuttering is probably the hardest thing for me to "get." There are times I think I "have" it, and then I find that I don't. I think that's because there are really two varieties of "acceptance:" one that's ego-based and another that is a higher or essential aspect of the self. Because of this, I think that a dicotomy is a natural thing to come up for people thinking about acceptance.
One type of acceptance is based in the ego and is more like "resignation" or the cessation of rejection. To back up slightly: The human ego and personality is based on rejection because it is erected in childhood to separate the self from pain and other noxious things that are overwhelming or damaging to the infant. Some of these things (for both girls and boys) are emotions. Others are behaviors, experiences, memories or other things that are unpleasant or that seem to threaten the child's existence, one of which is stuttering. Among the ways to reject stuttering are to try to control it or to avoid it, and these impulses are constantly reinforced by the superego messages learned from caregivers, from others and from the child's own projections that stuttering is bad and is definitely something not to be doing if one is to be "acceptable" to others. A part of this rejection is to lose or suppress consciousness of stuttering and of speech itself, a tendency that is (I suspect) what the recent PET scans of low left brain activity during stuttering may be corroborating. Because the ego is based on rejecting, it cannot possibly accept anything. The ego's way of "accepting" something would be to develop an overblown sense of "pride" in it, which is really rejecting its reality and transforming it into something else.
The other kind of Acceptance (with a capital "A") is an essential or higher aspect (that is, springing from consciousness) that puts the person in touch with the full range of human strengths and capabilities. In this aspect, the person would be detached from the fight or flight impulses of the amygdala. A part of this cleansing and refreshing experience of Acceptance (which seems to come on as part of my ego's cessation of rejecting), is the implicit understanding that the self is distinct from stuttering and any other behavior (including fluent speaking, for that matter.). Because this essential form of acceptance is a product of the higher brain, where consciousness resides, the person experiencing it knows implicitly that the negative self images and ego-based thinking that support stuttering are simply false. And there is no need to reject stuttering because the person realizes it is already something separate from him/herself. There is the sense that even if I stuttered for the rest of my life, I would be OK, because I'd survive/be OK (an aspect of basic trust). From this place, the person is free to engage the essential qualities needed to grow: curiosity (needed to investigate the behavior), strength (needed to work on it), compassion (needed for just about everything), will (needed to support the work day after day), joy (needed to release creative energy), etc.
The motivation is not to produce fluent speech, but to heal the self by regulating tension and eliminating pain in a natural way. Why is this so? Because words and beliefs are not the language of the brain. "Stuttering" is an abstract concept that is chocked full of ego identifications. Trying to tell the brain "accept stuttering" is like trying to tell your computer "start printing" by simply typing the words into the keyboard. It just won't understand what you're talking about because you don't know the specific language or code that relays what stuttering or acceptance means to the brain. The process of speech therapy requires acceptance to bring the healing power of consciousness to bear and creates more acceptance in the process. This is done through trying (as best as one can) to stutter without rejecting and then: 1) perceive and become conscious of the stuttering as it is manifested, 2) begin to consciously regulate and release the perceived tension (in whatever way the specific therapy approach does this), 3) experience and acknowledge the associated emotional tension, reactions, and pain, as they come up and 4) begin to heal the emotional and spiritual damage created by the former rejection of the self., which includes accepting the fact that this damage happened. That is really what "speech therapy" is and I think this process is common to just about every therapy approach that people have success with. It really has nothing to do with creating fluency, although that can be its result. But I would say that stuttering definitely is a "speech problem" because modifying speech is the key to healing it.
Of course, one is not able to have full access to Acceptance all the time. As long as the ego and personality still have a grip, they will work to reject this process. The realization that this is going to happen is a part of Acceptance.
This is based on my own experience with stuttering therapy but has been explained for me by my inner work, so it's probably a bit too metaphysical for some (many? most?) people to swallow. But the anecdotal evidence that people who experience acceptance seem to be almost magically motivated to grow should provide an indication that something real is happening. There is really nothing mysterious about this. This essential state is available to any human and has probably been experienced at some time or another by everyone reading this. For me, the PWS who most fully embodies the aspect of acceptance while still continuing to stutter rather noticeably is John Ahlbach (former Executive Director of the National Stuttering Project.).
The ability to engage acceptance requires a therapist who has very special qualities; a person who is a true healer. If these capabilities can be recognized by the "stuttering specialist" certification in addition to the educational and professional requirements, I'm in favor of it. This would best be reflected by the success with healing PWS, which is probably best judged by interviewing former or present clients.
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It was only 10:00 am--the very beginning of the NSP convention in Arlington, Virginia--and I was already freaking out. I'd just struggled through a brief introduction of a keynote speaker (Peter Ramig) to the convention, using every confrontive fluency technique I have--stretching those first syllables as far as I could stand (which, from my experience, is not as far as I think or would like). And I was standing there in the lobby of the hotel freaking out. ALL THESE PEOPLE STUTTERED. I don't mean stutter a bit or sometimes. They stuttered all the time, EVEN WHEN THEY DIDN'T SEEM TO STUTTER. I was seeing my stuttering self (that jerking, halting, "bleckburger" self) all around me, reflected in 400 men and women who made up the entire known universe. How could I stand this another minute?
You know the feeling: "How can I stand this another minute?" It's like someone is telling you from somewhere up above the chandelier: "Ha! If you didn't like THAT minute, just wait!" But somehow, the first minute passes and you're into the next minute. Which just sort of naturally flows into another one. Someone came up then and bravely introduced himself. We started talking and stuttering with each other. Things were getting better. This fellow I was talking with was not a "stutterer." He was a person. And then I remembered where I'd had that experience of horror before: it was the first time I'd ever attended a stuttering support group, 16 years ago in Washington, D.C. That was the first time I'd ever been able to really confront what I could look like to other people when I stutter.
As I stood there talking freely with this fellow, it was like the rush of mountain air just before a thunderstorm, billowing the curtains up; kicking back the door jambs; blowing the dust out of the corners, blasting the hot stale air right out of the closets, right out of the basement, right out of the house.
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I think one of the most important areas of my stuttering therapy and self-therapy is healing the psychological scars left over from years and years of abuse and self abuse. I think many of us tend to think that just because we've survived 20, 30, or 40 years of living with stuttering, we can pretty much handle anything that comes along without much trouble. I sympathize with this feeling. It seems healthy to think that one can deal with one's own "stuff."
But the first step in dealing with and solving a problem is to accept its severity. For too many of us, I'm afraid that this feeling that things are "not so bad" shades into denial. And a problem that is denied will never be properly addressed. Emotional damage must be faced, felt and grieved before it can be expunged. Sometimes I feel I've barely begun this process.
In his new book, Keeping the Love You Find, Harville Hendrix discusses the similarity of post-traumatic stress disorder ("shell shock") in combat soldiers to the problems faced by adults who were traumatized as children in dysfunctional families: "New findings demonstrate," he writes, "that even a single traumatic or terrifying incident, and certainly repeated incidents, can actually alter the chemistry of the brain, so that victims respond to normal events as though they were repetitions of the original trauma--with nightmares, sweats, rage, insomnia, irritability, and flashbacks to the original terror--though years or decades have passed."
It's important to mention that Hendrix discusses this in the context of making the point that trauma is trauma--whether it's physical abuse or emotional neglect--and that the defining characteristic of trauma is a feeling of helplessness. I think he'd agree that 20 or 50 years of actual public humiliation, gut-wrenching fear of speaking, and constant self-flagellation qualifies as "trauma."
Is some form of PTSD why it's so easy for that feeling of helplessness to pop up when we least expect it? Even after we learn that stuttering is something we can control? Even after we've learned conscious techniques to help us stutter more fluently?
Whatever. Just the thought that something serious is going on has been enough to motivate me. And help me be easier on myself when I do have difficulties.
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© 1993 - 1996 Darrell M. Dodge