Background and Misconceptions ...

People who are not familiar with stammering have no idea what it is like to have a full-blown adult stammer. They think it is a small interruption of the speech flow, causing the speaker to feel vaguely inconvenienced and that sometimes it is done deliberately for effect. Little do they know...

- Ann Irwin, Stammering in young children


What is stuttering?

What is stuttering? Most normal speakers have encountered a stutterer at some point in their lives, and in many cases the meeting was an embarrassment for all concerned. But there are also different kinds of stutterers; there are those whose speech does not bother the listener, and there are those with whom communication poses a serious problem.

Many fluent people probably regard stuttering as an unpleasant speech defect. It’s the type of problem your little nephew suffered from at school, ‘but he has improved tremendously. Just listen to him speak now!’ Few realise that this person may be using gimmicks to hide his poor speech – and that these gimmicks may in turn cause a variety of problems.

Or maybe a colleague of yours stutters at work. He is most probably a very good worker, ‘It’s just a pity about his speech. He would have achieved much more if it hadn’t been for his stuttering.’ Or perhaps you notice the stutterer ordering food from the waiter in a restaurant, or a drink from the air hostess, or when you ask him for directions.

The difference(s) between the stutterer and non-stutterer

The first question that springs to mind is: What is the difference between a stutterer and other people? A fluent person may also ‘stutter’ – for example when he needs time to formulate his thoughts. The normal speaker may occasionally repeat a word or sound: ‘I-I’m leaving on Wednesday’ or ‘But, but I still feel you should go home now.’ The fact is that fluent speakers do not always speak fluently. But compare this normal dysfluency with that of the stutterer:

He might say: ‘I-I’m lealealeaving on Wwwwwwednesday.’ Or else he can say the sentence perfectly, but only after distorting his face or stamping his foot. Or else he may reverse the word order in an attempt to make the sentence easier to say: ‘Wedwedwednesday I’m leaving.’ Or maybe he can’t utter the words at all – his tongue ‘freezes’ against his palate, or his lips refuse to part, leaving him temporarily mute.

The term ‘stuttering’ therefore is a misnomer that contributes to the general confusion. This term incorrectly implies that the disability consists only of sound and word repetition. In fact it also includes elements such as avoidances and secondary stuttering behaviour (see below).

Experts disagree on the exact feature or features that distinguish the true stutterer from other people. However one may safely state that the ‘stutter’ of normal speakers can be controlled if the speaker makes a real effort. In the case of the stutterer, control is not as easily achieved.

One reason for the misconceptions about stuttering is that most sufferers do not stutter all the time. Stuttering is intermittent. A stutterer may speak fluently for several sentences; then suddenly he starts stumbling over his words. His speech may be completely normal when talking to his wife or friends; but not when he has to address strangers.

Stuttering in history

Stuttering is as old as mankind. Moses was ‘slow of speech and of a slow tongue’ and asked his brother Aaron to speak to the pharaoh on his behalf, and later to read the Ten Commandments to the Israelites. The famous orator Demosthenes may have stuttered as a child, but improved his speech by placing pebbles in his mouth while speaking, reciting poems while out of breath and attempting to make himself heard above the roar of the waves.

Charles Darwin, Thomas Jefferson and the authors Somerset Maugham and Nevil Shute stuttered, while Charles I of England only stopped stuttering after losing his head! George VI, king of England during the Second World War, commanded respect for the speeches with which he inspired his subjects in spite of a severe stutter. The prolonged m-sounds of Winston Churchill (‘MmmmmmEngland will never surrender’) were remnants of a stuttering problem overcome during his adolescence.

It is even possible that Marilyn Monroe’s famous breathy way of speaking was the result of a technique to master a stutter. The American singer Carly Simon started stuttering when she was six years old. The author John Updike also stuttered.

Tennis star Boris Becker stutters when exposed to severe stress. Other famous stutterers include the Roman poet Virgil, the Roman emperor Claudius and the Dutch scholar Desiderius Erasmus. So the present-day stutterer finds himself in good company.

... but were they real stutterers?

Many books and websites on stuttering emphasise the long list of famous stutterers in history, understandably in an effort to encourage those who stutter and showing them that success and fame is possible in spite of the disorder. Using famous or successful stutterers as role models is, however, not without controversy. Some stutterers feel that the circumstances of each stutterer is unique and that people should not be compared in this way, pressurised to follow another’s footsteps and made to feel guilty if they are unable to live up to these standards.

Others, again, argue that we should learn from those who stuttered and managed to achieve success. An interesting possibility is that the professional success achieved by some individuals in their particular field results in a ‘virtuous circle’, where increased confidence due to the success leads to lower tension levels, which in turn result in improved fluency.

In recent times some doubts have also been raised on whether some of the famous stutterers of history really stuttered. In some cases it would seem that the individual only stuttered as a child and eventually outgrew it, as do about three-quarters of all stuttering children. In other cases the stutter may have been relatively slight and not debilitating. So the claim that a famous person ‘stuttered’ should be handled with some caution.

A source of entertainment

It did not take long for humankind to discover that the stutterer is an excellent source of entertainment for less sensitive souls. In the time of the Roman empire, crippled and disfigured people were displayed in cages along the Appian Way. One of these unfortunate souls, ‘Balbus Blaesus, The Stutterer’, made a living by attempting to speak whenever a coin was tossed through the bars. In the Middle Ages, many court jesters who amused the rich with their jokes, comical behaviour and speech, also stuttered.

Traditional remedies...

Stutterers often had to endure dreadful treatment. A variety of traditional remedies featured nauseating objects to be eaten or drunk, such as goat’s manure. In other communities huge quantities of purgatives were administered. In Japan, stutterers were forced to douse themselves with ice-cold water while exposed to winter winds in order to improve their willpower. In the Middle Ages, ‘treatment’ included burning the tongue with a hot iron.

At various times and places these unfortunates had to eat raw eggs, frogs’ tongues, a black cat’s flesh at midnight, or a snake at half-moon. Primitive superstition from a vanished era? The reader who believes that these remedies have fallen into disuse is referred to a letter which appeared abroad in a medical magazine in 1950, in which a patient reported enduring a severe thrashing in a deserted church in an attempt to get rid of his stuttering.

Many of these treatments were based on the concept that stuttering was a kind of language perversion, or devil’s language, or simply a bad habit to be eliminated as quickly as possible.

The well-known scholar Dr Charles van Riper writes in his The treatment of stuttering about a patient from Arabia who mentioned that, according to his community’s religious views, God is present in those who can exercise control. The opposite also holds true: if you can’t control yourself, you are under the influence of the devil. As a result, those afflicted with epilepsy, cerebral palsy and stuttering are shunned and thought to be possessed by the devil by the simple people of his country. The patient told how women would grab their children and run away in terror when they heard him stutter.

To this day some parents punish their children when they stutter. The history of folk remedies for stuttering is a sorrowful tale, with few successes, endless disappointments and increasing misery for the stutterer.

Not that all traditional treatment was by nature unpleasant! Van Riper tells of a ‘therapy’ that was apparently common in Arabia: A boy who stuttered was not treated until he turned sixteen. He was then taken to a brothel, where it was expected of him to speak continuously while having intercourse. It may have worked for some, but this particular patient said that it only caused him more problems. He was unable to have sex, and afterwards remained impotent for a considerable time.

Chronic stuttering is a persistent problem, and unfortunately many quacks and crackpots use this persistency to line their pockets. Beware of uninformed ‘experts’ offering expensive treatments on the internet and YouTube! On the other hand one should guard against the other extreme of rejecting all new therapeutic approaches. One should remain open-minded about new and improved treatment methods.

A feature of stuttering is the temporary relief provided by successfully reducing stress levels in one way or another. Exploiters easily cash in on this and thus benefit from the disability. The quack usually has a superficial knowledge of stuttering which he uses to manipulate the stress levels of trusting stutterers. For the same reason stutterers are easy prey for faith healers, commercial hypnotists and enthusiastic, but uninformed amateurs. This leads us to the next topic.

Lay opinions on stuttering

Lay opinions on the origin and treatment of stuttering abound. Many people believe that all stutterers are shy, or insecure or lacking in confidence and that this is the cause of stuttering (in fact these ‘causes’ are usually consequences of the disorder). That was what my English teacher thought in high school. When it was my turn to read aloud in class, I could usually not manage to utter a single word. At this point he would look up and say: ‘Oh, you’re the shy one,’ and instruct the next pupil to continue.

In the Netherlands one of my primary school teachers told me that my stuttering was just affectation. She must have been about forty, a desiccated figure with blue eyes, a slack mouth that never laughed and a weak chin.

At worst people think you are mentally handicapped, or scared. Unfortunately these views are occasionally reinforced by less talented writers who conveniently revert to the stuttering character when their imagination fails them. Time and again a stutterer is ridiculed in a film or TV series. Such portrayals reinforce the stereotype: a superficial and ignorant view of stuttering as a silly and mirth-provoking habit that is easily or mysteriously overcome, for example when the character meets a pretty girl.

A sense of humour?

The stutterer should not lose sight of the importance of a sense of humour, and the dangers of hypersensitivity. Over-seriousness can only result in increased stress levels that will negatively impact on stuttering. Those working in the entertainment industry should, however, apply higher standards of social responsibility and sensitivity when dealing with human disability. Fortunately in recent decades some films have explored this issue with great skill and intelligence. One only has to think of Children of a lesser god (deafness), Rain man (mental handicap) and My left foot (cerebral palsy) to appreciate what can be achieved when film producers do their homework on a specific disability before shooting the film.

Jokes about stuttering abound. The classic joke is surely the one about the stutterer who wants a haircut. When he stammers his way through an explanation of how he wants his hair cut, the barber also responds with a stutter. The customer feels that he is being made fun of and assaults the barber, only to discover that they both stutter.

Jokes like these pose a moral and ethical problem. They belong in the same category as racist jokes, jokes about cripples, the blind, the demented, etc. On the one hand some of these jokes are truly funny; at the same time they feed on the suffering and misery of others. I don’t know the answer; I only know that certain jokes no longer make ME laugh.

This does not mean that stutterers should not have a sense of humour. Eventually I also learnt to laugh at some stuttering jokes – but that was after my condition had improved. Prior to really facing my stuttering such jokes were deeply painful to me. At a later stage I nevertheless began to realise that a lot of the laughter around stuttering was not malicious.

It should be noted that the non-stuttering community’s response to stuttering is not always negative. According to Zulu tradition, stuttering is a sign of wisdom. This conviction may be related to some modern studies that indicate that stutterers as a group are of above average intelligence.

Some people believe that they have found a short and sweet solution to the problem. One of my teachers used to press his big, heavy hand down on my head when I really got stuck. This was such a strange experience that I actually spoke more fluently for a few seconds.

Much later I realised why this hand pressure sometimes worked. It was a distraction that caused my tension level to drop momentarily, and this drop in tension released my vocal cords which had locked.

On another occasion with a different teacher I was obliged to stand up and attempt a stammering translation into German. The teacher stopped me and told me to breathe deeply before speaking. All eyes were on me, and I did as I was told. To my surprise my fluency improved, and the teacher was obviously very pleased with himself. He told the class that ‘it always works’. At home I told my parents about it and they were delighted. I was convinced that all my problems had been solved.

Two days later I was back in the German class. This teacher was in fact a bad-tempered individual, and we were all terrified of him. He had the habit of strolling past the desks with his cane, and if you didn’t know the correct German plural form you would be given a good thrashing. When my turn came to answer, I was very nervous. ‘Das Kind!’ he roared. My answer was an incomprehensible stammering. ‘Breathe deeply,’ he shouted, but by then I was so tense that I could think of nothing except stuttering. The teacher attempted his primitive therapy several times, but in vain. Eventually he left me seated at my desk, probably outraged by the additional irritation of having his therapy fail in the presence of so many witnesses – and continued terrorising the other boys.

I could have crawled into the ground with shame and frustration: because I knew the answer, but could not say it; because I could not get the ‘breathing’ right; and because my speech had exempted me from a hiding. This last fact did not escape the attention of the classroom bullies, who almost daily endured the teacher’s caning, and automatically exposed me to the most damning charge of all: weakling, sissy, coward.

The German teacher, as so many people at the time, had no inkling of the link between stress and stuttering. Even so I would not want to judge these amateur therapists too harshly. Like so many stutterers and their families, not to mention society in general, they were – are – simply ignorant.

The miracle cures

In spite of this ignorance it would seem that some people have benefited from lay methods. I have known a medical practitioner who overcame his stutter. He told me that he was cured by a teacher who believed in the sink-or-swim approach. This teacher forced him to speak out in class, to read aloud and to give speeches as often as possible, apparently on the assumption that this would make him less shy. He described this therapy as hell on earth, but it did cure his stutter.

Similar cures, though few in number, do appear in the textbooks on stuttering. How can this be explained? It may be that the enforced public speaking improved the doctor’s confidence, thus lowering his tension levels below his threshold (see the chapter ‘A Possible Cause of Stuttering’ for details of this theory of stuttering). Consequently the stuttering reflex was not adequately activated and in time disappeared.

This is not to say that forced speaking will benefit all stutterers. Forced public speaking may well be so traumatic as to increase tension and aggravate the stutter.

Can stuttering be cured?


Children

Fortunately approximately three-quarters of all stuttering children rid themselves of the disability (with or without treatment), usually before or during their primary-school years. However, those who do not outgrow it become chronic stutterers.

Consequently it is of utmost importance to eliminate stuttering in a child as quickly as possible before it becomes a deep-seated problem. The general rule is: The older the person, the smaller the chance of overcoming it completely and the more difficult the treatment.

Adults

Adults who stutter have a chronic problem. The disability is deep-seated and is moreover ‘fed’ by the everyday tensions to which stutterers as well as fluent speakers are exposed. The negative psychological and social consequences of stuttering also contribute to tension, which feeds the problem.

Due to the fact that stuttering is stress-related, a lasting and complete cure is usually difficult to achieve. However, much can be done to reduce and control stuttering and stress and reduce their detrimental psychological and social consequences. Nevertheless effective control of stuttering usually requires a great deal of effort by the stutterer and depends on several factors, for example the individual’s sensitivity to stress, the strength of the vocal cord closures, personal determination, the quality and comprehensiveness of therapy and support et cet.

Why do more men than women stutter?

Statistics indicate that approximately five times more men than women stutter.

The exact reason for this is unknown. Prof Martin Schwartz, however, believes that men and women react differently to stress. According to him a woman’s stomach muscles are more sensitive to tension than a man’s. In the same way a man’s vocal cords are more sensitive to tension than a woman’s. According to him male genes are especially susceptible to this disability. Schwartz also points out the fact that the male larynx (the part of the throat and windpipe containing the vocal cords) is shaped differently to that of the female larynx and more inclined to lock.

No difference apparently exists between the stuttering of a man and a woman. However, it may be that the emotional burden of stuttering is more difficult to bear for a woman. Traditionally a woman is expected to be pretty and attractive.

The percentage of stutterers in the population (at any rate in the USA) has remained constant for several decades, ie approximately three per cent of all pre-school children and one per cent of adults. Apparently the problem occurs in all cultures, although it seems that there are fewer stuttering children in communities that do not demand such high speaking standards from their youth.

There are indications that certain Native American communities have fewer stutterers due to their lifestyle and culture. Research has shown that these Indians, in their own culture anyway, do not speak under conditions of stress unless they want to. When asked an important question, they feel under no obligation to answer quickly. The speaker will think about the problem for a long time until he feels ready to answer – and often his answer will not include any proof of his opinion (just think about those old Western movies, and how leisurely a meeting of Red Indian chiefs is conducted! In these circumstances there is obviously a minimum of pressure on a speaker).

The traditional fate of the chronic stutterer

Above it was stated that control should be a far more important goal for the adult stutterer than a permanent cure. One of the problems faced by the stutterer is that he usually lacks adequate knowledge of his disorder. In addition his expectations of therapy are often unrealistic. Some stutterers consult a speech therapist expecting to be cured ... only to be discouraged when they discover that completely fluent speech remains out of reach.

Moreover, stutterers do not always realise that speech therapists are not miracle workers. We are not dealing with a purely physical problem that can be cured by a pill, injection, operation, etc. The speech therapist is not a doctor. Apart from physical factors, stuttering also involves psychological factors related to the total human being: his stress patterns, personality, environment, value system, etc. In addition a large part of stuttering consists of learned behaviour and conditioned responses. As a result treatment can become very complicated.

In this way a truly tragic situation may develop: people going from therapist to therapist, and in the process becoming disillusioned or bitter. A member of the self-help club I joined had seen more than forty therapists in the course of his life. Most of the other members told of years of treatment.

But this also contains a cruel paradox. Often the stutterer experiences a dramatic improvement in his speech in the early stages of treatment. The patient feels new hope and optimism; at last he has found a therapy and a therapist that can help him! Unfortunately this does not last. A short-lived period of improvement is again followed by a relapse. What causes this temporary improvement?

Prof Martin Schwartz has an interesting explanation for this phenomenon. According to Schwartz the temporary initial improvement can simply be attributed to lowered tension levels. The mere fact of receiving treatment – regardless of the type of treatment – may temporarily lower the patient’s base-level tension (see the chapter ‘A Possible Cause of Stuttering’ for an explanation of this important term). This occurs because some guilt and other negative feelings are discharged during therapy. Sometimes the result is such a drastic improvement in the patient’s speech that he feels he no longer needs therapy, and terminates treatment. However, as the stutterer is again exposed to everyday tension and stress, his base-level tension gradually increases to the point where his vocal cords are affected. The result is a deterioration in his speech as he ends up yet again in the vicious circle of stuttering: more stuttering results in more tension which produces more stuttering.

Alternatively it often happens that the stutterer quickly becomes used to the therapist, so that his tension level decreases to such an extent that he becomes fluent in her presence. A therapist lacking proper insight into the nature of stress may then conclude wrongly that treatment has been successful, and discharge the stutterer, unaware that he will again experience all his former stress responses in conversation with people outside the speech clinic.

As a result the stutterer’s self-confidence decreases even more; not only is he unable to speak properly, but he sees himself as a therapy failure, because he was unable to progress. After a few similar failed attempts he decides that his specific case seems hopeless. He comes to terms with his fate and adapts as well as he can to the difficult circumstances.

He may choose a type of employment in which he only has to talk to a minimum number of people, often with a small salary and few chances of promotion. Often his employer intentionally hides him from the public eye. Someone who stutters does not make a good impression on customers – and the company does not want to frighten them off. And in his social life he may cling to a few sympathetic friends in whose company he is not tense. He is forced to live in a small, limited world.

Seen from the outside, things are not that bad for the stutterer. He has created his own stable world in which he can be relatively happy, provided that he remains within its boundaries. Often it is as if he never stutters, because he has found all kinds of ways of concealing it. But if you could read his thoughts, they would tell a different story. Buying stamps at the post office may demand immense preparation and various coping techniques. Making a simple, but necessary telephone call may present enormous problems.

The stutterer will spend a great deal of time avoiding such situations. In fact many stutterers are dependent on a specific group of people – usually the immediate family or friends – for help in difficult situations. Often people in this group do not realise their importance to the stutterer.

Opportunities for embarrassment are never-ending. I am convinced that many stutterers could write a book about the traumatic experiences they have been subjected to. In fact quite a number of such books have been written. An acquaintance of mine who stutters told me that as a child he attended a magician’s performance. He sat in the front row and the magician suddenly asked him his name, intending that he participate in a conjuring trick. A very unpleasant scene followed. The boy stuttered on his name for about thirty seconds, the other children burst out laughing and he ran out of the hall in tears.

It therefore comes as no surprise that speech pathology textbooks are filled with psychological reactions suffered by stutterers: fear, social anxiety, insecurity, guilt, frustration, aggression, poor self-image, you name it. Often the stutterer resorts to alcohol abuse or other means of escapism. I have known stutterers in self-help groups who have admitted contemplating suicide due to stuttering. No doubt some suicides are linked to stuttering, as is apparent from an article in Speaking Out, the magazine of The British Stammering Association, Summer 1993, page 5.

In this chapter we reviewed the general and social dilemma facing the stutterer. As is the case with a number of disorders, for example epilepsy, the affected person is to some extent a victim of the social consequences of the condition rather than of the disorder itself.

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