Wednesday, March 29, 1995

Core behaviors

In answer to comments by Woody Starkweather on core behaviors

A few points:

1. I am glad you agree that this deeper or initial "core" is a key to
understanding stuttering and to early therapeutic intervention. In this
case let me be less shy about suggesting that a good name be attached
to this concept in order to distinguish it from "traditional" core
behaviors. Thinking produces language and language produces new thinking.
Labels ARE important!

2. Assuming an "initial core" a transient state and a final steady state
("traditional core" ... my modeling background is showing), then lots
of research questions come up. How long is the transient? This the
period during which we learn our own very personal way of stuttering.
Months? Years? How malleable do we remain and for how long? I have been
always struck by the notion that learning a second language before about 11
years of age (in the new country) all but guarantees the ability to have no
accent, while after that age it's always a long struggle. And my
previous questions: how does coping during this period shape the stuttering
"style"? Is an understanding of how one coped initially and during the
transient a good prognosticator for the most appropriate type of therapy?
There is much work about how one learns language. How DOES one learn
stuttering? (good hints are coming out of your work!).


3. Woody, I was very surprised when I first found out that you were NOT
a stutterer! ... And that's the HIGHEST compliment. I really think that
you and many other (non stuttering) SLPs on this list understand stuttering
>From the "inside out" in a way I didn't think was possible. I find this
very reassuring. I wish there had been such a way to communicate years
ago...

Tuesday, March 28, 1995

Distinguishing "core stuttering" from learned behavior

In discussing stuttering therapies one needs to understand what the therapy addresses, and my point here is that much therapy addresses what can be considered "learned" behaviors.

I said

> In summary, instead of "show me how you stutter and I'll tell you what
> therapy will be best", I suggest "tell me how you have been coping with
> stuttering from the very beginning (i.e. what and HOW you are likely
> to have LEARNED) and I'll tell you what therapy will be best".

Woody S. pointed out that there is the possibility of misunderstandings in how stutterers define stuttering as opposed to how speech pathologists do. Stutterers think of repetitions and blocks as "stuttering" while pathologist often think also of the whole syndrome of maladaptive learned behaviors, such as eye blinking, word substitutions etc.

In answer to his point I wrote:

I was trying to draw a more subtle distinction, and I probably need
yet MORE help before I cause too much damage by clouding the picture
with my own brand new set of definitions.

I am addressing mainly core behaviors, and I am trying to assess how much
even these are the result of "coping". I'll try with some examples, then,
anyone, please feel free to suggest a set of clearer words, if what I
am saying makes sense.

I am a kid, and I suddenly start experiencing blocks. How do I cope with
this event? Some kids realize that they can substitute words, some feel
that they can blast their way through them come hell or high water, some
try to make it come out, give up, try again, give up and get into a long
set of repetitions. At a different level some will feel a great deal
of shame and try to avoid speaking, some will want to speak no matter
what. My point is simply that ALL of these kids will probably continue
to experience blocks but their blocking "style" will have been modified
by how they began coping with the problem.

So now you are the SLP and the kid (or now the adult) comes to you. You
see blocking, you assess its severity and start trying the techniques
you have had most success with. It seemed to me that the discussion
on screening and prognosis centered on the assessment of PRESENT
stuttering behavior. My question is the following:

Assume that two people have blocks of similar frequency and
intensity, but, at least initially, they "coped" differently with the
problem. Would they benefit from different therapeutic techniques?
Could their initial "coping style" be a prognosticator of the best therapy
for them? Are these considerations that enter the minds of SLPs when they
try to asses what to do?

Why am I asking this, and why do I think it might be important?

My hypthesis is that even much of what is viewed as "core behavior" is
in fact the result of a learning process, and that this process is guided
by your initial coping strategies. For instance, when I started blocking I
REFUSED to do anything that seemed "unnatural" to me. This included word
substitution and trying to use force to get the word out. Also, if a teacher
asked a question, ... and a little voice inside said "S. don't open your
mouth... you might be embarassed" ... my arm would go up in the air...
I trained it to that automatically! I was determined not to let stuttering
hold me back. It turns out that these were the right things to do, although
there was no therapist around to tell me that in post-war Italian public
schools. (Now I often ask myself, did I turn out to be a "mild" stutterer
because I did those things, or was I able to do those things because I was
a mild stutterer? But this is a slightly different issue)

In summary, I propose (but I am sure others have thought of this) that what
SLPs call "core behavior" is in fact the result of a learning process that
was framed by initial coping strategies. This initial pre-learning
behavior could be called.. sub-core?.. pre-core ...real core behavior? Help!
I guess we don't need a special word if this is not a useful concept, but if it
is...

Assuming then that a specific set of "coping" (different word needed?)
strategies led the PWS from pre-core to core... could these particular
strategies be better prognosticators for successful therapy than the
simple observation of core behaviors?

Whether or not what I said is useful, I hope it was clear.

Monday, March 27, 1995

Response to John Harrison regarding psychological factors in blocking

In response to John's complaint that the list has been unwilling to consider his proposed explanations of stuttering blocks.

John:

I think you are being unfair. Many of us have spent a great deal of time
discussing this issue with you and, speaking for myself, learning a
lot in the process. I am not sure why this wouldn't qualify as "willing
to explore it" with you, but, whatever it means to you, have you done
so with the "opposite" view?

I have learned the following from your view:
1. Individual word "fears", conscious or subconscious, could play a role in
increasing the tension that makes our speech machinery "break down" (I already
held this view, but you have certainly strengthened it).
2. Dealing with these fears in a psychological context can help "dimistify"
blocking behavior and bring our attention to the whole of speech where it
can be of most use. I would never have thought of doing this. Now I would
consider it a good bet in helping some people.

Now, have you "learned" anything from the "genetic view"?

In response to John's bemoning of the fact that many people "latch onto" timing problems, that we can do nothing about, because they would be genetic in origin.

"Genetic" BY NO MEANS means that you cannot do anything about it! Genetics
is only the initial blueprint. It is followed by an embriologic stage AND
by several developmental and learning stages. One CAN intervene and modify
the "natural" development of any of these stages if one knows what one is
looking for! Even when one misses the developmental stages it is sometimes
possible to find chemical, surgical and yes, psychological "fixes" too.
Treatments for depression come to mind as a good example. We are also seeing
the dawn of genetic engineering. Again the key is to find exactly what we should
be looking for.

My interest in the genetic cause is simply due to the fact that I think
it will ultimately illuminate the most productive course of action in
eliminating stuttering. And NO, John, I am not afraid of appearing
psychologically "weak" by not viewing blocking behavior as essentially
psychological in origin. You can bark all you want but it's the wrong
tree. I really don't give a damn about showing chinks in my armour. I am
afraid of snakes and hights. I have had to admit to myself and others
traits in comparison to which "the psychological load" of particular
words or situations absolutely pales.

In response to John bemoning his own perception that many seem reluctant to explore other non-speech related factor that may be relevant to the problem

Do you really think that people, like many of us, who routinely get up in front
of people "confessing" to be stutterers, would have a hard time admitting
(to other PWSs and SLPs) that some words or situations are psychologically very loaded to them? Loaded enough to cause approach-avoidance behavior? Please
give "us" more credit.

I am glad that you pointed out that none of this means that stutterers are emotionally or psychologically different from fluent folks.... now I can come out and stop this silly
denial game! Come on... do you really think "genetic weakness" is easier
to "accept"? Down (sp?) Syndrome is genetic, and so is a myriad of other
mental and physical conditions people are not particularly proud of.

John, I understand how frustrating it is not to have convinced the many
of us who have discussed this issue with you. I know it is frustrating
to me that the opposite hasn't happened, in spite of the flow of much more
eloquent statements than my own. But, please, simply accept the fact that
your arguments, although eloquent, spirited, and rooted in years of great
introspection, have met their counterpart on the other side. For you
to seek solace in the notion that we are in denial or "afraid" to look at
possible psychological factors, would be the real denial. I am confident
your practice at introspection will prevent you from falling into that
trap.

Sunday, March 26, 1995

Comments on list dialog and invitation to BTF

In response to a message from Janet Ackerman in which I was invited to join the board of directors for the Birch Tree Foundation (BTF).

Thank you very much for your kind words on my contributions. Like many
others, I am sure, I have been tempted to give up in frustration, but
I can't let misleading statements get to the stuttering community unchallenged,
and, curiously, I came to the realization that the fact that I am not a SLP
has given me an advantage in that nobody can accuse me of touting "rival"
therapies for personal gain! You and Woody have been very careful in mantaininga low key objective approach, but I am sure it must be hard at times NOT to
intervene more forcefully and become "censors". I am very glad you have been
able to trust that the PWS and SLP populations would be better served by lettingall opinions be expressed. There would be nothing worse than turning misguided
people into underground heroes.

The silver lining is, I hope, that even long, circular and unresolved
discussions are revealing how the "players" think and are educating people
on facts and methodologies. People who start off with radical positions will
rarely change their view, but I think there is a "silent majority" out there
who has been learning a few useful things.

A suggestion I have is, perhaps, to be a bit more proactive in getting issues
to the fore, so that new interesting issues get to be discussed instead of
being compelled to react to the old ones again and again. Sometimes the best
way to eradicate weeds is to plant a lot of "good stuff" around!

Now, to your offer. I am truly deeply honored that you would invite me to
work with people such as yourselves and the present members of the board!
With the caveat that, at this point, coming by travel money would be a
hardship for me, I would be thrilled to contribute to your endeavor. It
would eventually kill my "neutrality" but what the heck..

Fortunately a lot can be done nowadays with email, faxes etc. and I am
well equipped for long distance collaboration both in my office and at
home, so, let me know what you have in mind!

Wednesday, March 22, 1995

Control and stuttering variability

In response to the point that there is great variability in stuttering behavior

It's hard not to agree with that statement, but what does it REALLY tell
us? Not much unfortunately. Most of all it does NOT tell us that there
are different CAUSES for each individual, but only that there are
different ways of coping, and this is really not surprising. If you
catch a cold your body's immune system reacts, you sneeze, maybe have
a fever. None of these things are under conscious control so all human
bodies tent to react in similar ways.

Speech, on the other hand, is, at least in part, under conscious control
and is learned. It is not surprising then, creative as we are, we'll find
extremely individual ways to cope. If we had conscious control over the
symptoms of cold (or even if we thought we did..) and found that by
hopping on one leg or flapping one arm you could prevent some of its
symptoms, you'd find a lot of people adopting the strangest behaviors
during flu season and you'd say that colds too are as individual as people!

While this variability certainly calls for (and explains the relative
success of) individualized forms of therapy, it is important to try and find
the commonality of what is happening. Even the "argument" between John
and myself, I think, ended in what I perceive as a deep agreement in
how we both have dealt with blocks (i.e. dimistify the individual block
and look at the whole "speaking picture").

Even control vs. non-control is, in my opinion, a non-issue. This is
in part because we don't agree on what we mean by "control". Some people
think of "easy stuttering" as non-control. I think any injection of
consciousness in the mechanics of speech is "control". Again, it is
not surprising to me, given different mind sets and different learned
behaviors, that different stutterers may feel helped by fluency shaping
while others prefer easy stuttering. Still, the common goal is to produce
acceptably fluent speech WITHOUT having to think of the mechanics of it, and
many of us have learned that, in time, this can happen more and more.

I find it interesting that the closer stutterers get to fluency, the
more similar their stuttering "style" gets. Is this so "by definition"
since they are close to fluency?... I don't think so. I think that, as we
throw away much of the learned useless baggage, stuttering becomes quite
uniform. Do any SLPs agree with me on this point?

Friday, March 17, 1995

Objections to "Stuttering University"

In response to the problem of a "separatist enviroment" (problems "re-joining" the fluent world)

I share this concern, and considering that it took me years before
I could comfortably approach other stutteres, I surprised myself in
having changed my thinking. (What follows is part of previous private
posting) The university idea stems from solving the constant dilemma between approaching stuttering by focusing on it and by NOT focusing on it. One could get a degree without attending a single therapy session and yet have "worked" on
one's stuttering by approaching every subject in the context of his/her
path towards whatever degree of fluency s/he sees as a goal. All in
a supportive environment.

Women have used the "supportive environment" argument to justify women's
colleges. I don't know what it is about us stutterers... but even admitting
the need for a supportive environment seems hard to do. Perhaps because
of the 4 to 1 ratio of male to female stutteres there is a pervasive
"malist" attitude that we should be "tough enough" to take on whatever
comes our way. Dare I say that we need larger dosage of good nourishing
"female" thinking?

Response to the "relapse problem" following successful intensive therapy

The idea is precisely to prevent this problem. An "intensive therapy
environment" could not be sustained for 4 or more years. It would have to
become REAL life along the way... good grades, bad grades, your girlfriend
dumps you.. your roommate snores. A recent posting on how John H. and
I agree on this issue should clarify why I think this would work differently,
but I could be wrong, of course.

The more I think about it, though, the more I am becoming convinced that four
or more years where we can FORGET and NOT FORGET about stuttering and
LIVE, with it, without it, though it ... whatever .. could change the
lives of many people.

Response to the need for a better name... ("it's the people who stutter, not the university!")

Before it becomes real, if ever, I am sure we'll figure out a better name,
all the more so since (imagination being so cheap anyhow) I actually envision
some non-stutterers wanting to enroll. Why? The best SLP department, great
engineering, computer science and biology (for control, artificial
intelligence, brain modeling etc.), great liberal arts for personal
growth, international atmosphere, and yes, lots of PWSs... the best
bunch of folks that ever walked the earth (please allow me one of the
few elements of pride allowed to stutterers... you have to become a pretty
special person to survive stuttering with some degree of sanity.. and
most of us do! :-)).

To John Harrison: some points of agreement

Just when I thought that we had parted company and were merrily walking
in different directions I find you again! I agree so much with what you
said in your posting that I had a very hard time selecting just a sentence or
two for reference.

First of all, even though we don't agree on the "nature" of blocks, we
essentially did the same thing: we DIMISTIFIED THEM. You did so by
analyzing what you thought might be underlying psychological causes. I
did so by simply ignoring them, acting as if they hadn't happened and
moving on. Let me add an analogy to all your great ones.

Let's face it, we are lousy windsurfers in the "sea of speech". Fluent
folks seem to be able to navigate no matter how rough the sea gets. As
soon as a few waves show up down we go..

Now, if we really concentrate (focus on "targets" etc.) we can survive
a good wave, but, sure enough, here comes another one... and another
one. It's a lousy way to surf... no fun at all.. and pretty soon down
we go anyhow. Fortunately it turns out that in the "sea of speech"
we can do one very interesting thing: with some effort we can actually
LOWER the waves ("tension"?)! Great! So here comes a wave.. Quick.. remember
your techniques... concentrate.. LOWER the wave! Smack... you hit the
wave... sorry it's too late to do anything about it now... and down you
go. Why can't we lower every damn wave when it comes? Because if we
wait until each particular wave comes it's always TOO LATE.

What's the solution? Forget about each particular wave, look at the
whole sea, look at the sun, enjoy the wind pushing you through the
water. You CAN make the whole seascape calmer, and if you still fall once
in a while it's OK.

I found that when I switched from monitoring each single wave (word) to
monitoring the whole sea the going got a lot easier. Each block was
not an enemy to be conquered so I could go on to the next one (talk
about fatigue!), rather it was a signal, a reminder that a battle had
ensued that I wanted no part of. So I'd back off, wait for the seas/battle
to calm down, and I'd get going again. Eventually I found that I needed
fewer and fewer blocks/signals to remind me to calm the sea, and I found
that the blocks became less severe and often barely perceptible. I also
found that even the tiniest blocks, unnoticed by anyone but me, were still
very good "signals", so I didn't have to wait until major blocks to
remember to lower the waves... I could just keep them down constantly and
ENJOY my speech-surfing excursion.

What are the consequences of this view for therapy? You have just gone
through a two week workshop and you are doing pretty well. Now if you
could just keep doing the same "things" in the real world... right?

WRONG!!!!

You are not at the end of your therapy, YOU ARE AT THE BEGINNING! You have
learned to survive that big wave when it hits you, and that's a great
skill to have, but that's not speech. You have speech, enjoyable speech
(as it should be by definition) when you have learned to create the
conditions that make the sea calmer and calmer and when, in fact, the
techniques you have learned become easier.. and ultimately unnecessary.
It's no wonder to me that so often people simply tire out and "revert" to
the old ways. Techniques are not "solutions" to be harked back to. They
are temporary band-aids to get you on your way. My believe is that future
therapy will, in fact, include the much harder process of "removal" of these
band-aids... I have tried to illustrate here how I have tried to do just
that for myself.

John: I forgot I was "talking" to you... and got on my soap-box. From what
I have read in your postings, it seems to me that you removed your "band-aids"
in much the same way, and I think this is important feedback to both SLPs and
fellow stutterers.

Wednesday, March 15, 1995

Clarification on my stuttering competence

I have been sent private e-mail asking my opinion on various issues and
how they might differ from John Harrison's. With John, I have been very active
on the list lately, and I am very grateful for the opportunity to do so, but
I want to make sure there is no misunderstanding on my level of "authority"
just because my opinions appear frequently...

I am NOT a SLP. I am a scientist, trained in Physics (MA), Biophysics (Ph.D)
and Computer Science. I have been working at NASA for the past 15 years and
I am now doing research in the area of Neuroengineering. I am also a stutterer,
although on a good day you might never guess it. I have had only brief
encounters with therapy and I consider myself mostly "self-taught" in how I
deal with my stutter.

Now to John, me and dealing with blocks. John and I are friends and see
each other occasionally at NSP functions. I have NEVER heard him block or
repeat in any way that would make me think that he had ever stuttered, so
he MUST have done something right. I think my stutter is more easily
revealed but I am also quite satisfied with my own progress. The reason
I am posting this is that many might find it interesting to note that both of us seem to have overcome blocks by coming from different directions. This
certainly accounts, at least in part, for our "philosophical" differences in
this area.

John (I am sure he'll jump in if I misrepresent him) seems to have "studied"
each block as it happened, wondered what was about that particular word
that might have made him want to avoid it, etc. This increased level of
awareness slowly seemed to "melt away" the blocks (correct John?).

I, on the contrary, approached blocking by completely ignoring and quickly
forgetting any word I might block on. I felt (and still do) that blocking,
in its basic essence, was an "accident" that could happen on any word, for
no particular reason, and that, in fact, if I lingered on the word,
wondered why etc., I might add an element of fear to that word, which would
make it more likely that I would block on it again (yes, I recognized a
"psychological" component). I directed my awareness instead to my speech
apparatus as a whole, to decrease any tension in my body and promote
a general sense of well being and joy of speaking no matter what. What I
mean is that I would NOT think something like "oh my God, I've got to
speak... I'd better RELAAAAAX", rather, I would try to make my body
awareness INDEPENDENT of any speaking situation, something I could
cultivate through dance training (I took Ballet, Modern and Jazz training
for 7 years) and classical singing (I know we don't stutter when we sing,
but that wasn't the point). All of these disciplines deal with eliminating
even very subtle tension from your body to free it for the production
of beautiful movement or sound, and to make the whole process as automatic
and subconscious as possible so your mind and body are free to create "art".

I think I slowly learned to tap into that same state "on demand" and use it
to support my speech (and, when needed, the various techniques and "tricks" you learn in therapy). I am not suggesting that everyone should spend ten
years learning dance and classical singing (although it WAS GREAT FUN, and I
met my wife, a beautiful dancer, along the way), but simply that this path is
SLOW, so we might as well try to make it fun, in whatever way suits us best.
Having seen how difficult it is to achieve the subtle control it takes to
become a good dancer or a good singer I have a hard time even conceiving
how anyone can expect that even a few weeks of therapy will "cure" stuttering.
Yes, you can learn tools and tricks that can come quite handy, and can
get you started on your way. But from that point to feeling a true joy
in speaking is a long way... but I really don't mean to sound discouraging,
it can be a FUN way too.

One last thing (apologies for the length of this). I should just mention
that this is precisely the context in which I proposed a "Stuttering
University": a place where stuttering can be "forgotten" and worked on
at the same time... all while having fun... learning... and living.

Wednesday, March 08, 1995

On "blocking"

Continuing a dialog with John Harrison in response that his feeling that blocking is a "strategic response"

Yes, we part company. It feels to me like a bunch of sand has been thrown,
so to speak, onto my speech apparatus. And that causes me to stumble, not
everywhere "at random" but at linguistically significant points, such as
word beginnings. I think not because these words are somehow "loaded" but
simply because they are there. It's as if speaking is like crossing a stream
by hopping on stones. If your legs get weak you end up slipping and stumbling
on some of them.

John feels that there is always an "approach avoidance" conflict present in blocks. He asks "how do I know it's not present"?

That's right, I don't know, and neither do you. I think it's great that,
having both had the dubious "advantage" of feeling stuttering from the
inside, we have concocted different "models". This should give some
reassurance to our friends SLPs who don't stutter!

We agree on so many things that I had lost sight of (or never understood) what
we did not agree on. It really would be boring and perhaps hopeless if we
all marched in lock step. The important thing is we have identified two
possible "models" (if mine can be thus dignified). You attach important
psychological udertones to blocking, I, while not denying that
these could play a role, see "generic" tension as a more direct cause.
Your mental image is "approach avoidance" conscious or unconscious, mine
is "sand in the machinery". I think these different views can have therapeutic
consequences. The next step is to see whether there is any
evidence out there to support one or the other. Do any SLPs and or researchers
on the list have an opinion and/or can cite evidence to shed some light?
(As usual... sorry if all this is old hat..)


Response to a "defender" of Dr. Schwartz's therapy methods

I am really happy that you and many others
have achieved the best results you could have hoped for. This is a credit
to both Dr. Schwartz and to your determination. I can (believe me) feel
the pain you must have gone through in so many false starts and false
hopes, and I understand your desire to share your success with everyone.

Unfortunately a scientific forum like this one must seem quite stubborn
and cold-hearted at time. The very simple fact is that Dr. Schwartz's therapy
has been an equally painful false start for SOME stutterers. I know,
if they had REALLY done it... but this is precisely one of the very
legitimate issues we have been trying to pursue. There is NO SLP I know
who has not had what they would regard as "failures".

So where does that leave us? Many people have come on the list stating
that they had received benefit from Dr. Schwartz's therapy. Nobody had
any negative reactions to their saying so. I personally reacted to your
postings simply because you came across, at least to me, as saying "here
is someone who has THE answer and nobody is paying attention for some
unspecified warped reasons". Well, even aside from my own differences
in thinking, most postings I have seen on this list have found fault
with some aspect of Dr. Schwartz's model, or of his definition of "success".
This is a simple fact I felt obliged to state. Why? Simply because I
think stutterers should be able to make informed decisions.

It is also a fact that many, including me, have paid attention, asked
questions, agreed or not agreed with answers, and conducted what I feel
has been a fair, albeit often inconclusive, debate (I am still ready
to send you what I have collected, if you are interested).

Can I ask you to please help us continue in this fashion? Dr. Schwartz
has been perfectly capable to conduct the debate about his model and
his therapy. Your testimony has been noted. Could you tell us what
hadn't worked in past therapies? What your specific objections are to
other models? I am sure you could come up with more.

There is no conspiracy here. We are all in the same boat. Many of us
have been through a great deal of pain, and all of us are trying to
spare it from others both close to us and far. Let's help each other
do so.

Tuesday, March 07, 1995

Dialog with John Harrrison

Thank you for taking the time to point out and address in detail many
crucial statements made by Dr. Schwartz in his book. This has been a
great service to us all whether or not they will be "dismissed" by the
author. I agree with you in the general thrust of your arguments, and they
bring to mind a couple of points I would like to make.

It is clear to me that progress in stuttering recovery is greatly enhanced
by (or even requires) bringing together the best of our mental capabilities or,
as you aptly put it "getting our s**t together", but this is NOT because
stutterers are inherently less together than the rest of the population
(one just needs to attend a few NSP meetings to convince oneself of this
fact), but simply because the beast is hard to tame and we must gather
all the strength we can get, wherever it is. For most people speech is
a nice stroll in the woods, for us it is mountain climb. Strollers can
get by with average fitness, we need to be athletes, mental athletes.
I pointed this out in the context of another post, but it's worth repeating.

The other point, where perhaps we don't agree, but it's worth a discussion,
is your concept of blocking, essentially Sheehan's approach avoidance. My
past experience of blocking might fit, in the sense that I remember fearing
certain words and sure enough... I would block. But relatively soon, I realized
that fear or no fear, if I monitored my general level of tension and eased
into the words, they would come out fine. In time this of course decreased the
fear and made the whole thing easier, essentially reversing the cycle. But
here comes the clincher, occasionally I still block, but is seems to be right
out of the blue, no fear of words or situations, it's just like russian
roulette. What is still true is that, if I monitor (and lower) the degree
of tension of my whole speech apparatus these "surprises" occur very rarely.

So here is what I think. For reasons yet unknown our speech apparatus
(yes the WHOLE system as you would say) is particulalrly vulnerable to
tension and there are several areas in which it can "break down". One of these
is the articulation at the beginning of words (here is where the
SYSTEM comes in, including the cognitive levels where the idea of "word"
is formed, as opposed to low level causes such as "spasms"). Yet, while
approach avoidance increases tension, it is GENERIC tension that cause
(by yet unknown mechanisms) blocks, NOT the specific tension surrounding
avoidance of a particular word. This still implies that approach
avoidance behavior is very likely to be associated with blocks, but it
allows for a situation, like mine, where the absence of this behavior still
does not guarantee the complete absence of blocks.

In summary, approach-avoidance -> tension -> blocks. When approach-avoidance
is the overwhelmimg source of tension then it looks like a direct path
approach-avoidance -> blocks. BUT, even when there is no approach avoidance,
you can still have tension (from other sources) -> blocks.

Does this make any sense to you or others? Are there therapeutic
consequences to this view?

While I am on the subject of blocks, I have always felt uncomfortable with
notions of "airflow blockage" as implied by the Valsalva maneuver analogy.
I have certainly seen people exert a lot of effort to get a word out, including
face contortions that might remind one of suffocation (I learned to "give up"
at the first hint of effort), but It seems to me
that many blocks are actually accompanied by a lot of sound and flowing
air. The cords are vibrating, air is coming out, what is blocked, it seems
to me, is the ARTICULATORY process, i.e the MENTAL process of moving on to
the next sound. It is as if a pianist tried to play a melody and only managed
to play the first note, the pianist then tries again, and, again, only the first
note comes out. They keys are fine, it's the hand that can't continue. It's
this mental "hand" that gets stuck, the next nerve impulse that's supposed
to come down the pipe, but won't. Can others confirm this observation
or am I dreaming? I hear blocking on vowels and sounded consonants I can
recognize... so air and sound are coming out! Why can't we go on to the NEXT
sound? That, to me, is the key.