Wednesday, January 25, 1995

Model-1

To M. Schwartz

> We have gone around in one big loop. In an earlier message you
> described three apparently seperate "theories" of stuttering (organic
> based, tension based and learning based), then made the following statement:
>
> > > "So, as you can see, all three theories are correct and all have their
> > > appropriate place in the model"
> > >
>
> To this I replied the following
> >
> >
> > Indeed I think all three "theories" are "correct" i.e. they cover
> > likely important aspects of the stuttering phenomenon, but I fail
> > to see how your model is a particularly parsimonious way to account
> > for them.
> >
> > An organic weakness can easily make someone more vulnerable to
> > tension (some people blush instead of stuttering - my palms sweat...AND
> > I (used to) stutter under tension). In addition, when faced with
> > difficulties, we learn behaviors that seem to help us overcome them.
> > Sometimes these behaviors end up being worse than the problem. Persons
> > who blush may cover their faces with their hands, which may end up
> > being more noticeable than the blushing...
> >
> > In this context one can have therapies that work at decreasing tension,
> > unlearning unproductive behaviors and/or learning good ones, and, if
> > a good drug is found, the "root" organic problem might be addressed
> > as well (too much or too little seratonen...or what have you).
> >
>
>
This simple explanation of how these ideas can easily be combined in
> providing a rough accounting of stuttering behavior is what I called
> "model 1" ... just as a reference point. I make no claims of having
> created or proposed a model that is "mine". Model-1, it seems to
> me, (please SLPs correct me if I am wrong) underlies most therapeutic
> efforts in stuttering.
>
> My question to you was and is very simple: are there stuttering behaviours
> which can be accounted for ONLY by your model and not by this
> reference model (Model-1)? I really would like to understand.
>

Monday, January 23, 1995

Stuttering "cures"

This is a response to a post where M. Schwartz compares his stuttering therapy to an "antibiotic" that could cure everyone... as long as they agree to take it...

The "bacterial infection cure" analogy is a perfect example of the
kind of complete misunderstanding of the stuttering phenomenon that
has plagued relationships between PWS and SLP. I am sorry for
letting go of my customary scientific circumspection. This is a
stutterer speaking now, and one who is very grateful for the kind of
care and real understanding that is being dispalyed by most SLPs on this
list.

You put me in a room, ask me to focus on fluency for a reasonable
period of time and you won't be able to tell me apart from any
other fluent speaker. I have learned to control my speech so that
I don't stutter if I put my mind to it. Am I cured? Can I then set
forth and "Stutter no more"? In analogy with the Cristian Scientist,
am I making a CHOICE not to use the speech "tools" I acquired because
I believe that God willed it that I be a stutterer? Do I have some
perverse psychological reason for refusing to use the tools that
would liberate my speech for good?

The answer is NO to all of the above. The simple fact is that
the controls that enable me not to stutter require a constant mental
effort that fluent speakers do not have to exert. The problem
is not that I am unable to exert control or that I am unsuccessful
at it, the problem is that I HAVE to. THAT is the problem. Therapy
that focuses on providing these control techniques is certainly
welcome for those who need it, and many do, in order to do the
many things we have to do to survive, but please don't call it
a cure! The problem is still there even if we can momentarily
get around it.

People leave therapy programs because they either have difficulty
accomplishing these speech "control" tasks, or because they
realize this is not what they thought a "cure" would be. In some cases
they even feel that exerting speech controls is far more cumbersome
than stuttering.

This is the reality of the stuttering phenomenon, and this aspect needs
to be accounted for by any "model" of stuttering just as much as
all other obvious external manifestations.

It is also the case that speech controls can become less cumbersome
and more "subconscious" with time (my experience). Perhaps new
neural "remedial" pathways are formed, just like learning a new
language. This "model" however does not account for "sudden cures".
So, there are four possibilities: they are not really "sudden",
they are not really "cures", the phenomenon was not really
"stuttering" or the model is wrong.

The law of parsimony

> Dr. Schwartz:
>
> This is getting a bit tangled, but let me try anyhow.
>
> You started by presenting three "separate" theories of stuttering and
> went on to state that your model nicely accounts for all of them (the
> ONLY model that does so, you further added in your reply).
>
> I stated that the three "theories" seem quite compatible to me and that
> they already formed what could be viewed as a reasonable "model"(let's
> call it Model-1 for future reference) . I asked therefore what your
> model added to this "simpler" (i.e. more parsimonious) model.
>
> You stated in your response that your model is "extremely parsimonious",
> further more, if there is any complexity I don't understand you'd be
> happy to explain it to me.
>
> OK. now I can clarify my point:
>
> "Parsimony" means to explain all the facts with the least amount
> of assumptions. You make some clear assumptions about the role
> of vocal cords (thank you for your misspelling correction - caught me
> red faced on that one). What additional explanation do these
> assumptions provide, which Model-1 could not explain as well?
>
> There are two good reasons for adding complexity to models: explaining
> more facts and providing for the possibility of testing (which still
> is a form of "more facts"). I still don't see which facts your model
> explains which are nor explained by model-1. With regard to testing,
> I praised your model, in that it opens up the possibility of discussing,
> indeed testing, the role of vocal cords in stuttering. But here again,
> you seem very quick in dismissing evidence that might challenge your
> assumptions. You claim that repetitions in sign language do not obey
> "rules" of stuttering and considering them is "misleading and confusing".
> What rules are you referring to? It would in fact be very interesting
> to see how different this type of stuttering is and whether any
> differences are a rather obvious result of the differences in communication
> channels or hide something deeper. Also, could you provide a couple
> of examples of how, in your thinking, the laryngectomy papers you have
> had the time to survey tend to support your model?
>
> By the way, I do not equate "complex" with "unclear". As a Ph.D. in
> Biophysics and NASA researcher for 15 years in areas from
> closed ecologial life support to artificial neural networks, complex
> models and scientific methodology are my daily bread.
>
> Let's keep trying.

Thursday, January 12, 1995

Three aspects of stuttering

To Martin Schwartz (about three aspects of his model)

> Indeed I think all three "theories" are "correct" i.e. they cover
> likely important aspects of the stuttering phenomenon, but I fail
> to see how your model is a particularly parsimonious way to account
> for them.

Schwartz answers that only his model integrates all three aspectw in a comprehensive way. As such he believes it is parsimonious.

>
> An organic weakness can easily make someone more vulnerable to
> tension (some people blush instead of stuttering - my palms sweat...AND
> I (used to) stutter under tension). In addition, when faced with
> difficulties, we learn behaviors that seem to help us overcome them.
> Sometimes these behaviors end up being worse than the problem. Persons
> who blush may cover their faces with their hands, which may end up
> being more noticeable than the blushing...

Schwartz agrees that there is an organic weakness

>
> In this context one can have therapies that work at decreasing tension,
> unlearning uproductive behaviors and/or learning good ones, and, if
> a good drug is found, the "root" organic problem might be addressed
> as well (too much or too little seratonen...or what have you).
>

Schwartz agrees

> What additional explanation justifies the extra complexity of your
> model? I do see one advantage in the detailed cause-effects you
> have spelled out - as I understand them - and that is that there
> are instances where the model can be seen to fail. The model I
> very simply expressed is NOT very useful in the sense that it is hard
> to figure out a test case where it would fail. Again, a good model
> is one for which one can at least think of a situation where, if the
> situation applies, the model fails. If a particular model can never
> fail it's not particularly useful, and this includes the one I
> expressed.

Schwartz denies that his model is "complex" and doesn't understand my second point
(if there is no situation for which the model can fail, then it's not a good model - This is a fundamental concept in science)
>
> Now, your model IS useful in postulating the dominant causative role
> of vocal chords, because now we can test it! If the vocal chords are
> not involved stuttering shouldn't happen. Evidence has been cited, such
> as stuttering behavior in sign language... and you have dismissed it
> as irrelevant to the problem. I am still scratching my head trying to
> figure out how you can possibly consider it irrelevant. How could
> it be more central? Also, have you had a chance to look at the other
> evidence involving vocal chords (I don't recall whether it dealt
> with surgery or paralysis, but it was cited by Woody and you said
> you wanted to find out more about the extent etc.)?

Schwartz doesn't consider stuttering in sign language "stuttering", so point is irrelevant to him. He also claims that the laryngectomy literature supports his model.

>
> While I am stirring the pot, let me bring up one situation that
> is not explained even by the weak model I presented. You mentioned it
> in a response to the list: that of "sudden" and "complete" cures.
> I encountered one person who claimed to have awakened one day with
> not a trace of his previous stuttering. I also know of people who
> claim to have had out-of-body experiences. Are we here in the realm
> of parapsychology or have serious studies been done of such cases?
>
> I can see how "complete" cure can be a matter of perception. I could
> start saying that about myself and probably nobody would argue, but
> "sudden"? As if someone could shake a loose wire in the brain and
> re-establish a missing contact? Any ideas?
>
Schwartz says that he will relate his experience on people who "stopped" stuttering later on.