Wednesday, October 23, 1996

Computer models of the brain

> From: Darrell Dodge
...
> But there are neurological processes that could be hypothesized to play a
> part in situations like Vicki's.
....
> Enough. This hatchet-job would probably not impress my biopsych prof. And
> that's just one reason why I need to be hitting the books instead of
> continuing here.
>

Darrell:

It impressed me! It's great that you are able to even begin to think at this level of granularity. It's true that rats can't talk, but it's not completely unfeasible to turn some of these neurological ideas into computer models. Computers CAN speak. The way they have been programmed to do so, so far, has nothing to do with how we produce speech, but it wouldn't be impossible to build a speech producing mechanism based on the kind of control issues we are talking about.

My dream is to produce a speech producing apparatus with a little knob, such that, if I turn the knob a bit, stuttering starts happening. Now, if someone can give me some good arguments why NASA should be funding this type of work...

Some time ago Megan Neilson sent me some very interesting papers on the work she and colleagues were doing at the Univ. of New South Wales. They built a mathematical model (Adaptive Model Theory) according to which a problem in auditory tracking could be responsible for stuttering. The point I want to make is not whether or not their model is valid for this purpose (I've been hoping to get the time to study it carefully...), but that it is in fact possible to start building such models! If Megan is still listening she might give us an update on her work...

Anyhow, Darrell, keep up your model thinking... even though it's sure to be above many of our heads... especially mine.

Thursday, October 17, 1996

Onset and ending of "Sudden Fluency"

Victoria Benson reported on her own experience of "sudden fluency" for a period of about two months after an accident (brain stem injury). Then the stuttering returned.

Vicki:

How did people "explain" to you this occurrence (sudden fluency)? It goes completely against all "learning" models. It is as if someone were to suddenly start speaking French...

From a neurological point of view, however, this can be explained as a very organic effect, such as a chemical produced as a result of the injury and recovery process, which happened to offset whatever causes our neurological problem. As the recovery process ended, the original "set point" took over.

Unfortunately this is a kind of experiment I WOULDN'T want to take part in...
Glad you made it back stuttering and all!

Wednesday, October 16, 1996

More on the radical neurological position

Marty Jezer stated that "the core neurological problem is not a singular problem. There is no one stuttering circuit that governs stuttering/fluency (just as there is no one gene that causes stuttering"

Marty:

You could be right, but does it hurt to think of one core cause for a start? Let's look for the most likely ONE... and if doesn't do the trick let's look for more (..Occam's razor). The issue of speech circuits and genetics are related, but different. Genes are simply "switches" that set a whole development process in motion. In this context I would also bet against a "single gene" for stuttering. But suppose the problem is simply caused by low levels of some chemical whose production is dictated by a
particular gene... It may be unlikely, but not entirely implausible.

I don't think nature would create a "circuit" for stuttering, but, given a well developed and honed circuit for speech, there could be a particular weak link, such that, if anything is going to break, that's the link that's going to break. As part of my job, we flew one of the early Apple Powerbooks on the Shuttle. With all its complex circuitry, there was one fuse that had a tendency to blow up for no apparent reason. We were lucky - it didn't break - but we were sweating it (BTW, no danger to people.. only to an experiment!)

Mary continues:
> Speech, being as complex as it is, is subject to
> many areas of vulnerability, and many different singular and
> interactive neurological glitches.

Again, we really don't know. Some symptoms (sneezing, for example) can have multiple different causes (dust, allergies, colds etc.) and some have a clear specific cause. Complexity, in and of itself, doesn't imply several equiprobable failure modes. The heart keeps on going and going. The most common serious mishap is a heart attack ... and then the symptoms are clear. You could be right, but let's not use the "multiple glitches" possibility as an excuse to throw our hands up in desperation. Give me "one" glitch ... and the others will follow..

Marty also stated that drug research isn't really looking for a "fluency pill", rather for a pill that might lessen brain excitation and thus "affect the threshold of motor malfunction"

Some drugs can cure causes, some can cover symptoms. If the latter is the
best we can do, I'll take it!



Woody Starkweather stated his objection to the "radical neurologial" position on the grounds that, once the onion is peeled (using my metaphor), there is virtually no problem left.. just some "behavioral residue" so small that it is not likely to be the result of some neurological flaw.

You stated the objection and then you actually answered it. I've personally been stuck with this possible "behavioral residue" for a long time. The reason why I remain somewhat active in the stuttering community is no longer the need to find a cure for myself. Stuttering has stopped being an issue for me. I just feel that this "behavioral residue" is the KEY to the problem. From a therapist's point of view, the problem has practically vanished. I think that this is the point where one can finally start addressing and studying the real problem (from a researcher's point of view). The point is not that we need to push the "cure" further (although I wouldn't mind) but that understanding the core problem could prevent in the future the accumulation of all the upper layers.

Another "perverse" reason why there isn't much left after peeling away at the layers *could be* that the layers allowed themselves to be peeled away only because the core cause abated. Just like most children become fluent after "stuttering" periods, possibly aging, in some adults, also affects a "cure". I have mentioned this several times and I am surprised that this possibility hasn't been looked into (that I know... do set me straight). Let's study "recovered" stutterers!

Let me also mention that I must concede that between your emphasis on early intervention and "core neurology" there may be only a semantic difference. As we have discussed in the past, it is often impossible to differentiate soft from hard circuitry in the brain.. and when one turns into the other, and if and what effects the early environment has on this process. If presumably the core problem is "structural" I have no strong arguments for stating that this faulty structure had to be present at birth as opposed to say after 2 or 3 years of childhood development.

Do we start with a only very vague predisposition whose "hardening" could almost always be avoided (with the right care), or do we start with a predisposition whose hardening is usually inevitable? From fetus to the first few years we must understand what we can do and when. I consider your work well within these very important parameters.

Thank you!!! (And thanks also to all the therapist who work at the "upper layers" to relieve so much pain and to help make us functional..)

Sorry about this long post, but everybody had been making such good
points that I couldn't resist packaging it all together.

Tuesday, October 15, 1996

Issues with a "single theory" of stuttering

Andrew Carpenter comments that no single stuttering theory could cover all the levels indicated by the "onion" metaphor, so searching for such "single theory" is "misguided"

Andy:

I agree... but the HOPE really is that if the core phenomenon could be
addressed directly BEFORE the developmental aspects take hold, then further
"upper layer" theories, while interesting for an understanding of learning,
would be unnecessary for "curing" stuttering.

He comments further that while there are good reasons to pursue neurological research, there is a danger of unneeded "radicalization".

Given the forces at play (the whole theapeutic community -understandably-
deals with the upper layers), I doubt very much that we run the risk of
becoming too radicalized in the neurological direction.

Thursday, October 10, 1996

Biological "set points"

In answer to a statement I made earlier:

> >The more "radical" neurological position holds that there is such a "core".
> >and that, if we could get to it directly (say by some surgical or
> >drug procedure) the whole "onion" would *probably* just collapse and melt
>> away.

Andrew Carpenter commented:

> As you say, at this point this is speculation, but it does seem
> implausible to me. Even if we were able to take a "fluency pill" or have a
> fluency operation, or whatever, there would still be all the emotional,
> attitudunal, and socialization problems to deal with. Although I could
> understand secondary behaviors melting away, this other stuff would still
> have to be dealt with.
>

Andy:

I'm SO happy you keyed in on this, because this is precisely the notion, however speculative, that some of us want to bring to the fore.

Most biological systems have "set points" of stability. The speech system is no exception. Start with a neurological problem and you build all kinds of coping mechanism to be able to communicate. In combination, original problem and coping mechanisms establish a stuttering "set point". This point is VERY stable, as many of us would attest. SLPs do a valiant job at looking at the mushy multifaceted result. They will help chip away at some of the (bad) coping mechanisms, and push the set point towards fluency, but the tendency (as many will attest) is to get right back to
the stuttering set point. This is not surprising according to this model.

STUTTERING KEEPS GETTING "RE-INVENTED"!

If you could simply "remove" the original neurological problem, my believe is that even well entrenched bad habits, such as looking ahead for feared words, struggling etc. would just "melt away". Would it take weeks, months, years? I don't have a strong feel for the answer, but I know that at this point the natural set point would be "fluency", and it would be more difficult for the body to stay away from it than to fall back into it.

A good analogy is obesity. A therapist can look at a 300 lb person and find all kinds of reasons why this person is eating too much. With much struggle this person can be helped, but the "natural" tendency is to fall right back to the 300 lb set point. If you could change the set point to 160 lb, all those seemingly insurmountable psychological problems and bad eating habits would vanish of their own accord.

Speculative? Yes. Implausible? No. And, as Richard H. often points out, the consequences of defining stuttering in terms of its final manifestation (multi-"causal", multi-faceted etc.) has a profound influence in how it is dealt with by the medical community, insurance companies and by researchers. Yes, (to state the radical neurological belief) there is a SINGLE core cause, and, we'll find it...
________________________________________________________________________

Wednesday, October 09, 1996

The radical neurological view

Andrew Carpenter said: "stuttering is a complex, developmental disorder that is going to have several significant causes, one of which certainly may be a neurological predisposition.

And here is precisely where the difference lies. Everyone will agree that, at the point where "full blown stuttering" has become entrenched, it has BECOME a multi-faceted problem, requiring intervention in different areas (my "peeling the onion" metaphor), because that's the only way to get to the "core".

The more "radical" neurological position holds that there is such a "core", and that, if we could get to it directly (say by some surgical or drug procedure) the whole "onion" would *probably* just collapse and melt away.

Acceptance while working on improving

To Vera Chaplin who wondered how "acceptance" and "working on overcoming stuttering" can coexist

Vera: this is THE dilemma and the crux of any recovery. I'll give you
my answer (but each has to find hes own).

Work is the long term (beautiful) journey. Acceptance is for tripping along the way. It actually gets easier to accept tripping along the way, once you know that you have your eyes on a distant horizon. Note, like all horizons "fluency" will keep receding, but that's OK too. The journey is fun and tripping along the way will become less important and less intense. At some point you may find that you have been walking merrily for a while, enjoying the countryside, and won't know whether you haven't been tripping or you haven't paid attention to it. And you won't care which it was.

To Luc F. De Nil on brain scanning

Great to have you back!!!

Now a question. What results would you expect to see in "recovered" stutterers (one might also differentiate among "methods" used to obtain some degree of fluency). Have you already tried this?

Specifically, would you see differences among fluent speakers and stutterers who could maintain fluency during the experiment by
1. fluency shaping techniques / slow speech / hightened "control"
2. general monitoring of "state of being" with NO word anticipation (my "technique")

Would you see differences among fluent speakers and stutterers who claim to have completely recovered?

Did any of your subjects stutter freely, with no tension and no "looking ahead" for words?

As I have mentioned in other posts, if you ever need stutteres who claim to have achieved some good degree of "recovery", I'd be glad to volunteer. I love Toronto. I used to visit it quite often when I was in grad school in Buffalo...

Again, thanks for taking the time to talk about your work.

Tuesday, October 08, 1996

Usefulness of brain scans

Woody points out that brain scans are useful for seeing how the brain functions during the speech of stutterers, but not in showing the "cause" of stuttering.

All the more, as someone else also pointed out, it would be very interesting to look at the patterns of those who claim to have to a large extent "recovered". If no difference from fluent speakers shows up, this would strengthen the notion that the scans only show behavior. If a difference shows up in "recovered" stutterers in spite of fluent speech, THAT would be interesting. Unfortunately neither occurrence, it seems to me, would prove or disprove a neurologic deficit, but it could add a piece to the puzzle.

I'd be glad to volunteer for a completely fluent performance with my head in the machine... (somebody please tell Luc).

Tuesday, July 09, 1996

More on "Mysterious blocks" #2

Excerpts from a continuing conversation with Woody Starkweather .

".. So, sure there must be something that occurs in the brain before a block, but that doesn't mean that the problem is a neurological problem"

Yes, it would be a mistake to make a blanket assumption that any motor/language problem will have its origin in the brain, but if I had to place a bet for stuttering I would indeed put it closer to Tourette's. The learning component, which is of course present, is what leads many people to make the opposite "mistake" of assuming that you can explain the problem entirely as a maladaptive learning process. It seems to me that, while open to the previous possibility, you see the learning component as one that can be attacked and used to advantage very early on. Here I agree with you, in spite of coming from the opposite direction. *IF* it is possible to compensate for a neurological problem, doing so early on, while there is still enough plasticity, presents
the best opportunity. Whether one views this as "compensating" or "preventing" is really splitting hairs.

"...What gets stuck is the mechanism for producing speech sounds. Why does it get stuck? I don't know what it gets stuck in the first few occurrences, but very soon after that the child begins to be frustrated and starts to struggle. This struggle becomes part of how he or she talks and gets "locked in" when plasticity of development is lost. Then secondary behaviors are learned, and the development goes on."

We are very close here as well. As I have often pointed out in the past, genes do not code for the nervous system in the same way a detailed blue-print does for some physical apparatus. They set instead a long involved construction process in motion, a construction process that, in time, gets more and more affected by environmental factors, first in the womb and then continuing after birth. Learning itself has clearly a different effect on the brain in early childhood than in adulthood, and there is a fuzzy continuum in between. So, even as die-hard "organicist" I have no idea at what point along this process one might actually be able to recognize this hypothetical (maybe even surgery/chemically-fixable-removable-whatever) problem.

Maybe the "locked in struggle" that becomes the real problem could be "organically recognizable". Maybe it becomes a reflex for pumping out an excess of some chemical or what have you. If this is the case any neurology vs learning dichotomy vanishes.

I have tremendous respect for your therapeutic approach designed at preventing this possibility. I wouldn't risk a child's stuttering on certainly unproven assumptions that this is not what happens. I have in fact taken to heart all the information you have kindly provided me with in regard to my own child. In my moments of fear I wished I lived Philadelphia, so I could whisk him over to your clinic to be on the safe side (BTW even his minor hesitations -he never struggled- have almost completely vanished). So, my interest in speculation is purely for the sake of generating models that might at some point be testable, and which explain as broad a range of experiences as possible.

Here is one:

Whereas I have no doubt that struggling behavior can be learned, I think the difficulty in eradicating it comes not so much from loss of plasticity as from continuous reinforcement due to an organic problem. It is as if struggling behaviour is learned "over and over" , against the natural tendency of the system to "do the right thing". A corollary of this model is that, if one could conduct the hypothetical "surgery" experiment, struggling behavior would quickly vanish.

I suggest that what early intervention might do is to prevent the setting up of the "circuits" that, given the organic problem, trigger the learning of struggling behavior.

The difference from your position is very subtle, but it may be important precisely because it clearly opens up the possibility (in principle for now) for forms of medical intervention in adults. It also explains why people like myself and others you mention, who no longer identify any aspect of their stuttering with struggle, fear of words etc., STILL feel they are stutterers and indeed may have occasional surprise blocks or repetitions. I feel I have either unlearned my "pathways to struggle" or have built newer more effective ones.


Woody points to two types of recovery: one is where secondaries are eliminated, and what remains are "innocuous behaviors not identical with but similar in duration and frequency to normal nonfluencies". He conjectures that "some very deeply learned part of the struggle" may still be present, or perhaps even a neurological problem. A second type of recovery is where stutterers, after they "give up the stuggle", become "perfectly normal speakers", although in his experience most "still occasionally stutter a little".

It seems to me that the "model" I just proposed explains precisely these experiences, and is in concordance with your experience with early intervention.

About post recovery incidents Woody comments that they report that "their feelings begin to change just a little before these incidents. They begin to be a little afraid that they might stutter".

Not for me. I am more likely to stutter if I get extremely excited about what I am talking about and I don't give a damn if I stutter a bit, which leads me to believe that I've built "alternative pathways" which require at least some low level monitoring, so that when ALL of my energy goes into thoughts, these pathways become less effective. In these cases I stop to regain the mental state that allows me to continue being fluent.


Woody names a number of people who reported those experiences although he agrees that "it is also possible that some people don't have any fears anymore and yet still stutter a little". He adds "The disorder is so individual that generalities are very difficult to make with any confidence.

So true!

Sorry for the long post, but this interaction actually helped me define a model I hadn't quite been able to verbalize in the past. I had talked about a "forcing function" ... now I'll call it "continuous maladaptive learning" (CML?). Thanks!

Wednesday, July 03, 1996

More on "mysterious blocks"

(Excerpts from a discussion with Woody Starkweather)

"Just to throw my two cents in, I agree with Joe. There is no evidence for a neurological block"

Is there evidence for any other etiology of blocks?

"and what evidence there is suggests that at the higher neurological level stutterers are as fluent as everyone else"

What does it mean to be "fluent" at "higher neurological level"?

"All attempts to find differences in neurological functioning have been negative"

I thought interesting differences in brain scans have been reported. Granted that one can debate about what these differences mean, I thought they were there and worth studying

"This is not to say, of course, that the brain is not a party to the blocks that occur. It could not be otherwise."

What role would the brain play in your opinion?

"But the assumption that the cause is in the brain is just that -- an assumption with no evidence."

Considering that the brain is where the whole process gets started, and that all mechanisms that are external to the brain appear normal in stutterers (fortunately nobody suggests any more that our tongues should be cut), I would consider it a very strong assumption.

"Joe's explanation fits with the facts much better, specifically the tendency for stutterers to stutter in situations where they have experienced a lot of stuttering in the past"

As usual this begs the question of why stuttering should have started in the first place. The assumption here seems to be that some beginning tendency to "stumble" a bit (not YET a problem i.e. the neurophysiology of this child would not be different from that of a non-stutterer) becomes a problem after more and more inappropriate behaviors are learned in order to avoid the original non-problem. At some crucial point these learned mechanisms become so ingrained (indeed in the brain - is this the role you see the brain play, Woody?) that they are hard to impossible to completely unlearn.

This assumption seems corroborated by the common experience of both therapists
and many stutterers that as soon as they start chipping away at some of these
inappropriate behaviours (forcing, scanning ahead etc.) fluency improves.

Where we get in trouble, I think, is in assuming that, at least in principle, the process could be pushed all the way back until you are left with no "original" problem. This is the "unlearning" analog to the hypothetical "brain surgery" thought experiment mentioned by Richard H.

Admitting that there is no "evidence" for either assumption, I find the extrapolation assumption much less compelling than that of an original neurologic cause for the following reasons:

1. The natural tendency of our physiological systems is towards stability and towards recognizing and eliminating errors. Children fall a lot while learning to walk, but they all learn to do it right. I know of no physiological mechanism where an original "non-problem" becomes a problem by compounding and learning inappropriate behaviors.

2. Where learning is involved re-learning or unlearning can be slow and frustrating. But nothing compares with the stubborness with which stuttering "comes back". My native language is Italian and for years I have been speaking English in complete comfort (I came here at 16). I still do have a slight accent (I am told) but I have made no great effort to eliminate it, and no Italian words pop out of my mouth at random the way occasional blocks still do.

3. There are plenty of syndromes whose cause nobody would dispute is neurological and which cause faulty communicative or kinestetic behaviors: Tourette, Autism, Depression, Parkinson come to mind immediately.

In a nutshell I see no examples of "compound learning of inappropriate behaviors" (except at the "highest levels" of stuttering) and I see plenty of examples of neurologically induced behavior problems.

"specifically the tendency for stutterers to stutter in situations where they have experienced a lot of stuttering in the past and to have the feeling that they are about to
stutter in those same situations. No one has yet been able to separate the feeling from the behavior."

Not true. I NO LONGER HAVE THE FEELINGS YOU MENTION, yet I will occasionally still stutter or block. Help me people, I seem to get no aknowledgment of this very simple and basic fact. Only John H. has responded to this with the notion that my subconscious is still playing tricks on me (in the framework of his psychological theory or blocking). Given the little silly words and situations this happens on I must have a very warped subconscious. I just don't buy it.

Am I the only stutterer who experiences this?

Monday, June 24, 1996

More on stuttering as "inappropriate control"

Excerpts from a discussion with therapist Barbara Dahm

I certainly agree that "paying attention to ones speech" contributes a lot to the syndrome. As a therapist I would also attack this aspect (as I have for myself). What I react to is the notion, implied at least by some, that this is the "essence" of the problem. I am worried that the pervasiveness of this notion has hampered serious research in stuttering.


"Therapies usually are about finding appropriate ways to pay attention"

Agreed. In the end the only "appropriate" thing to do is not to pay attention, but the best way to get there varies from person to person. What was appropriate for me was to bring the attention from the speech level to that of my overall "state" of being (tension etc.)

"motor processes like skiing, walking, dancing, playing tennis do disintegrate when under conscious control"


I think you are reinforcing my point here. The body typically "knows" how to establish the needed "unconscious" control. We have very sophisticated learning mechanisms that can tell the difference between fluent and non-fluent speech, and everyone has enough periods of fluency for the body to figure out how to do it right. In stuttering, our brain not only hasn't learned how to do it right consistently, it even learns how to make it worse. I cannot believe that after millions of years of evolution we are so maladapted to do that in the face of some initial "mistakes" (akin to falling as a baby) or environmental pressures.. UNLESS there is some fundamental mechanism that is not working right.

"we have to stop trying to look for the one and only cause. A whole system is involved in producing speech"

There are two separate issues here. If you are dealing with therapy you do have to somehow break down the "system" and, in this sense, I agree that looking for "one cause" would not be of immediate use. However, if your purpose is to really do research in stuttering and eventually find a "real" cure, I think "one cause" that might precipitate other concomitant factors is quite a worthwhile pursuit.


"The fact that you don't think about the words most probably contributes to the fact that your blocks are rare"

Yes, in my less humble moments I also attribute my great strides in fluency to my change in approach to speaking over time. Other times I wonder whether age alone would have done this anyhow and I am just fooling myself (and others...). This is a point I keep coming back to, but I seem to find no "takers". What I am asking in essence is: is there a form of chronic adult stuttering that tapers off in time? The analogy is with childhood stuttering... only it takes 40 years instead (I am now 51).

"Perhaps speaking is difficult at certain stages in (children's) development and this causes them to put more conscious effort into the task."

Perhaps... Yes, you make a good point. I would bet against it, but this could be researched if it hasn't already.

"People who stutter need to produce speech, not push words out. That means that all of the processes have to work correctly including not thinking about words"

... and including whatever neurological mishap set the whole system up in the first place. What I wasn't agreeing with was that thoughts or perception of inherent "difficulty" might cause the problem in the first place.

(about my point on stuttering as a "comunication disorder")
"Yes, the listener does influence PWS's to use more controlled speech processing so they stutter more when communicating with others."

Maybe, but what I was really saying is that the unconscious ways in which the brain gets set to "communicate" , neuron excitation, chemicals whatever... is in fact different from that of the brain "at rest".

"This is just another opinion as well but I came to it by learning from my clients and seeing what allows them to make gains in therapy."

Both your observations and your successes speak for themselves. I hope my musings about causes, and love for discussion, were not interpreted as doubts about your therapeutic approach.

Friday, June 21, 1996

Stuttering "because" of (unneeded) conscious control?

The question was posed as to "why people don't stutter when alone or with pets"

(My answer) I have stuttered talking to my dog during a nightly walk.. (and I consider myself "RECOVERED"!)

Barbara Dahm's answer was that "people stutter because they try to consciously control the way they speak".

I wish I had a dollar for every time I've tried to question this theory. We pay attention to our speech BECAUSE we have problems with it, we DON't have problems because we pay attention. It is certainly true that "paying attention" can in fact make things worse, on the other hand isn't much therapy about finding "appropriate ways" to pay attention?

Why don't we have 2% of the population falling all over the place because they somehow developed the bad habit of looking at their feet?

The (fortunately) rare times when I am still caught by a block, invariably come as a complete surprise. I absolutely do not pay attention to my speech and do not "fear" the word I block on (I did have such fears early on).


(Barbara:) "some possibilites are that this is learned behavior"

Some behavior is certainly learned and can add to the original problem

" a reaction to an inherited weakness in the speech system"

This is my belief (with inheritance and other factors playing varying roles)

"a reaction to the belief that speaking is a difficult task and must therefore require more than automatic processing"

I very much doubt this. Look at children... they just simply "do it". If they stumble it's because, for them, it is in fact difficult sometimes, not because they "think" it is difficult. Stutterers become frustrated precisely because they know it "isn't" difficult, as shown in their wonderful moments of fluency... yet they have problems. We PUSH and think "why isn't the damn word coming out???". Our problem is not in believing that speaking is difficult, it is in believing that stuttering is difficult (please forgive the slight paraphrasing of Van Riper - correct attribution? -).

" just to name a few. Maybe some of the PWS's on the list can come up with some other reasons."

well Barbara... one good reason is better that lots of bad ones, and you did have it. To answer specifically about the alone vs not alone business one simply has to understand that stuttering is not a "speech" disorder, it is a "communication" disorder that affects speech. The process of communicating original thoughts sets up the brain in a state that is different from that of the brain "at rest" or singing or reciting etc. Apparently it is in this state that our "breakdown" is most likely to occur.

Of course all of the above are merely opinions strongly held by me and many others. It would be great if they could be definitely proven right or wrong.

Wednesday, June 19, 1996

Stuttering in children of PWS's

I think we have a HUGE opportunity to do something here. The following points have come out loud and clear:

1. The idea that early intervention may be the best opportunity to prevent stuttering seems to be one that both "psycho-environmentals" and "organicists" (I am one) can agree on.

2. Most parents who don't have experience with stuttering tend to follow the advice of pediatricians and "just wait"... This makes pediatricians happy since being right 90% or so of the time is pretty good track record...

3. A small percentage of the same parents will bring a child to a stuttering clinic and simply trust that the treatment will be appropriate.

4. Ironically, parents who stutter aren't in the mood to either trust the pediatrician (we were the 10% that got stuck with stuttering) or the clinic (real competence with stuttering has seemed all too rare for adults - present list excluded - ... will it be easier to find for our children?).

Is it any wonder that parents who stutter(/ed) are tearing their hair off?

Just to relate my own experience: I have a 4 year old. About 1 or 2 years ago he started having occasional whole word repetitions, seemingly without effort or frustration. In one instance, however, the repetition seemed to go on forever... He still seemed to take it in stride, but my wife looked at me and my heart sank to my feet. I was bracing for a rough going from that point on, but instead he settled into his previous occasional effortless repetitions. I sought advice from an SLP on this list (to whom I will be eternally grateful).

His advice included things I could do (and which I did, although fortunately the need seemed to remain relatively rare) and the notion that the approaches different therapists will take to dealing with children indeed vary, and he could not endorse them all.

So here is the rub. It's not just a matter of PWS trusting or not trusting SLPs. If you put 10 SLPs in a room and asked how they would deal with your child your would get ...well probably not 10 substantially different answers, but at least a couple of "camps" with fairly intense disagreement. Now, this is only natural and should come to no one's surprise. As adults we have the "luxury" to try out what works for us and there are members of this list that would swear by one camp or the other. The problem is that with children, we are told, the "window of opportunity" closes rather quickly, and all therapy "camps" are buoyed by the high success rate due to spontaneous recovery.

By this time I have little hair left... SO WHERE IS THE OPPORTUNITY I mentioned at the beginning? These I my suggestions:

1. Stuttering organizations should conduct an "all out" educational outreach to parents and teachers.

2. SLPs should make their approaches and philosophy regarding treating children as explicit and clear as possible. If "labels" are possible all the better, but this information should be made available in a national directory. The idea is that parents should be able to look at this directory and make an informed decision on the type of therapy they want their children to undergo. Again, there is no time for trial and error here... so, we need to know as much as possible in advance. Of course if all SLPs could agree on what's best and possibly create a specialization area in childhood treatment, that would be great too!

Fundamentally parents ought to be told not only that it's a good idea to bring children to therapy ASAP, but also WHAT types of therapy are available, WHO is doing it and where (Ira would surely add "how good it is" but I am sure that would be too much to ask of any humans...).

To end on a happy note, my child continues to talk quite happily. At this point he shows some occasional very minor mid-word hesitancy (as if he needed to catch his breath to finish the word) and no repetitions. He talks non-stop sometimes even in Italian (which I speak to him constantly). I keep being alert, but my worry has considerably lessened.

Wednesday, May 15, 1996

Stuttering and a career in science

A grad student asked about the effect of stuttering on a scientific career.

If you have enough interest in a subject to get a PhD, by all means get it! True, part of a scientist's job is communication, but "good" communication doesn't necessarily mean fluency, in any case there is a wide variety of research "styles" and abilities that can certainly allows for stuttering (OK a PWS is probably not going to be asked to be the next Carl Sagan for a TV series)

Overall I think that the Scientific/Academic communities are probably more tolerant than most in that they have the welcome tendency to look more at content than form.

Also, whatever your stuttering severity is now, don't assume you are stuck with it for the rest of your life. We disagree a lot on causes and thearapies (less so) on this list, but you'll see plenty of testimonials of people for whom stuttering has become less and less of a problem. I include myself among them.

I am not sure I would meet your measure of "successful" as a scientist, but I do know for sure that the ways in which I have fallen short have been due to other human shortcomings that have absolutely nothing to do with either my past or present stuttering.

Monday, May 06, 1996

Still on "good" Italian singers and "broken" stutterers

Look, Winston, I KNOW you were not trying to be demeaning. I am a trained singer myself (..yes tenor... the kind of voice that just gravitates towards Neapolitan classics - even though I'm from Milan -). I understand what you are talking about, but even in this area I have found pockets of "benign prejudice" that would juxtapose words such as LUSTY, BRIO, STRONG with sloppy, uncultivated, lacking in subtelty and on and on. It's not important whether or not you think Italians sing well or not. And even if you do, it doesn't make up for reaching what is MOST PROBABLY a wrong conclusion from your quite legitimate observation.

Winston is still wondering if there is a connection between the fact that the Italian PWSs "seemed", to him, " broken" ... "defeated" etc? And the way Italians tend to talk.

I have been saying two things:
1. Probably not, in spite of your observation, because
a) there are factors in Italian culture that could potentially offset the
negative (from a stuttering point of view) ones.
b) I would want to know more about the following: how many stutterers from other backgrounds do you know? What is your relationship with these stutterers? It sounds like they might be your students, in which case you might be confusing the kind of deference Italians feel for teachers with undue shyness and yes, your position could well produce extra embarrassment for stutterers. If they are your students then it shows that these people are subjecting themselves to the extra pain of facing a teacher for the sake of their art (is this "broken"? - but I'm just conjecturing).
c) One can question scientifically whether in fact loudness and vocalization have any effect on stuttering. I don't think so, but one COULD study this and one certainly SHOULD before coming up with labels such as "broken" for ANY category of people.
d) The evidence seems to be that there are about the same % of stutterers in all cultures, and they seem to be about as well adjusted as anybody else in the same culture.

2. One can certainly question point d) and bring in more conflicting evidence, BUT, particularly in light of the potential sensitivities involved, it would be wise to exercise some degree of circumspection and care in stating the questions and in proposing answers. This goes for IQ tests emotional test etc.

You keep saying "basta" and I agree, but there is simply no way I'm going to see the word "broken" associated with stutterers from ANY culture on the basis of the kind of observation you have stated, and just let it slide. Thousands of people read this. I don't advocate "Political Correctness" or ignoring areas of inquiry because of sensitivities. All I'm saying is: if it is sensitive it had better be real INQUIRY and not a casual comment you might throw in at a dinner conversation.

- How about stopping here (and/or taking it off-line... do I hear a chorus of yesses?)

More on stuttering and Italian

Further remarks were made on the supposed effects of Italian vocal mannerisms on stuttering.

I can only re-iterate what I said above. It's fine to speculate on whether certain conditions in one's upbringing can have a negative effect on stuttering, but to immediately generalize them to an entire culture, without bringing in other aspects of that culture that could in fact have a positive effect is really misleading and potentially hurtful.

This is the same kind of attitude that has brought us Polish jokes, prejudice against African Americans etc. etc. AND, btw, prejudice against stutterers in general (how can you go through life with that kind of handicap without going bonkers? ... Either that, or you were bonkers to start with.. which is why you stutter...).

I came to this country at 16 (for one year) and then at 20 years of age as a student. I was absolutely shocked at the "image" Italians had, and at the general paternalistic attitude I saw towards them (us). For one thing, most Italian immigrants to North America, came, as might be expected, from a specific socio-economic stratum and specific ethnic areas, but, while I am willing to concede that some characteristics that have been pointed out may be prevalent in these circumstances, to make a leap to a presumed worsening of stuttering or one's psychological makeup ("broken"!) is, at the very least, highly questionable.

This level of "enquiry", if it can be so dignified, is not useful (careful comparative cultural studies might be), but I am spending time on this because, whoever is so willing and ready to classify as "broken" the few Italian stutterers they have met, should at least know of one whose only "broken" parts are his PALLE (Italians will understand...) with the pursuit of this line.

Thursday, May 02, 1996

Stuttering and "loud" cultures

Winston Purdy commented on the possible effect of "vocal aggressivenes" in some cultures on stuttering. In particular he said about Italians: " I have met several Italians who stutter and they are all very shy and appear broken as people."


There are three issues here:

1. Do different cultures affect how many people will end up stuttering?

2. Can Italian culture be fairly portrayed the way you have (including
Italian stutterers as "broken" people)

3. Assuming the "loudness" aspect is true in general (and not socioeconomic -
note also that having lots of vocals has nothing to do with loudness). Would
this automatically affect stuttering severity and/or rate in the population?


Here are my answers:

1. I have only heard evidence to the contrary (can someone help?)

2. I will admit that my mother tended to be loud (she came from the town where
Pavarotti was born...). Other people in my family, and my father's side were not. I am an Italian stutterer. I doubt anybody who has even known me would ever have viewed me as "broken". I certainly haven't!

Many aspects of Italian culture would in fact be very supportive. Strong familiy bonds and pride, display of emotion, hugging and physical affection. My mother (unfortunately) treated my stuttering like a bad habit I could get rid off, and that didn't help. On the other hand she never showed anything but pride in me. If anybody had made fun of me she would have given them a bloody nose right on the spot.

My father ignored my stuttering, loved me to pieces, and was my best friend.

Overall I feel my upbringing had bad points and good points... just about like everybody else, Italian or not.

3. I doubt very much that loudness would have any effect on stuttering. People adjust to whatever the accepted level is, and go on from there. We develop fear of words, sounds etc.. Having to say them loud or not added nothing to that fear in my experience.


Overall the notion of the effect of cultures on stuttering is interesting to explore, but one should, as always, be very careful with sweeping and superficial generalizations. There MAY be interesting information here... but one can also hurt sensitivities needlessly.

Ciao to all.

"Unbrokenly" yours,

Tuesday, April 30, 1996

Fluency: When is enough enough?

I often participate on this list as someone "who has overcome stuttering"... Then I qualify it by saying "to a large extent", or I say something like "it's no longer a problem". The fact is that I have a very hard time labeling myself at this point.

The fact is that I continue to call myself a stutterer both for philosophical and practical reasons. My philosophical reason is that I believe in an organic component to this affliction, and I believe that my efforts MAY have helped me compensate for it. It is also possible that it would have followed that natural course for me in any case. Still, if it were possible at this point to go into the brain and know exactly WHAT made me prone to stuttering in the first place (yes, John I mean blocks too)... it would probably still be there. In this sense I call myself a stutterer.

My practical reason is the very well known positive effect of "acceptance". If I do accept that once in a blue moon I can still get caught by a surprise block, I won't make a big deal out of it, and panic, and think "OhmyGod it's back...!"

The fact is I now NEVER enter any situation, be it phone, meeting, public speaking, argument, whatever, with even the slightest concern that I might stutter, and I usually don't. When I do it's most often only noticed by me or it's quickly brought under "control". I had major problems in these areas as a teen and beyond (I'm now 50).

So, am I fluent "enough"? Yes, I am fluent enough to give priority to just about every other aspect of my life. No, I am not fluent enough to think that I can't improve any further or that I can't learn something from this list.

Friday, April 26, 1996

Rewiring neurological pathways


Marty Jezer stated: "We must learn to neutralize the stressors that incite our disfluencies and, also, in that learning process, rewire the neurological circuitry that creates, not an addiction, but the predisposition to stutter"

Marty, I think this is a very good analogy. By the way, I haven't had time to participate lately (and I shouldn't even now) but I find you have been doing a great job representing just about exactly what I consider to be my position (assuming anybody cares). The "rewiring" business reminded me of a recent experience I've been meaning to share.

I was lucky to be able to participate in an experiment conducted my Mark Lytle for his thesis (I've had permission to talk about it). This consisted in reading materials while attempting voluntary stuttering. He asked a range of people from severe stutterers to people like myself who claim that stuttering is no longer a "problem". I won't go into what he was trying to show (we were being monitored for physiological responses). My only point is that I was first asked to read a passage with my "normal" speech, which in this case was completely fluent, then with voluntary stuttering.

I've always thought that voluntary stuttering is a great therapeutic tool, and I still do, but what I found interesting in my case, is that my voluntary stuttering had a definite tendency to become involuntary! I could feel "faked" blocks suddenly become "real", while my body was tensing up and it all started seeming too much like bad old times...

I've often asked myself if the process of overcoming stuttering involved "re-tuning" our appropriate neural pathways or essentially creating new ones. This experience, subjectively, made me feel like the old pathways were definetly still there... ready for me jump right back into them.

I'm not making and scientific claim here... just a very subjective observation that might stimulate some thoughts.

Monday, April 01, 1996

"Conquering" stuttering (and fear of the phone)

A list reader asks how any of us "conquered" stuttering..

Like probably everyone else, I've been waiting for someone else to answer you... The problem is that you are asking THE question everyone wishes they had the definitive answer to! If you lurk a while longer you'll see that we have varied opinions and heated discussions on this matter. Some of us also feel that they have indeed "conquered" stuttering, but this has not ended our discussions: how did you do it? Does "conquering" mean the same to you as it does to me? Would it have happened anyhow in time? Do MY stuttering and YOUR stuttering actually have the same cause? ... and it goes on and on, and it will go on and on until someone comes up with THE answer, THE drug, or whatever... that works for everybody...

You might want to gain access to some of the past discussions stored in
various repositories (an update anyone?). In any case, in time, you'll
find ample food for thought and good suggestions on this list. Just
a short while ago there were numerous suggestions circulated on the
phone problem. If someone collected them s/he could send them to you
(hopefully somebody has already done it privately)

Friday, February 16, 1996

Different causes for different people?

Jason Tharaldson asks if there might be different "types of this thing we call stuttering", each with different sets of underlying causes

You make a very good point, and one I have thought a lot about. The short
answer (IMO) is yes, it is possible that different underlying causes could be
at the root of stuttering for different people. One can't help conjecturing
this when one is faced with people like John H. who stopped stuttering,
people like myself, who are viewed as fluent by most people they encounter,
and other people who seemed to be saddled with a seemingly much more stubborn problem. I do have, however, a more elaborate answer (based on my "onion") ... but I promised John I'd shut up for a while, so I will.

Thursday, February 15, 1996

A Mind-Body dichotomy?

William Rosenthal mentioned a case reported by child psychiatrist Erick Erickson, who treated a girl with focal epilepsy, by increasing (without medication) her resistance to life stressors.

The very same account could be made by many who approach stuttering exactly the same way: "increase resistance to stressors", and we know how varied the meaning of "successful" can be. Did this girl never have seizures again? Were they reduced in intensity? If the account indicates that effectively a permanent organic change was induced by the therapy, then this is a great example that reinforces the notion of early intervention with children at risk for stuttering. Thank you for providing it!

William Rosenthal makes the point that in fact any changes must happen in the neural circuitry, therefore the mind-body dichotomy is "a dead issue".

If I really sound like I am talking about a mind-body dichotomy then I am in
real trouble! My concern is that this "functioning of neural circuitry" be
refined MUCH further. Getting drunk affects the functioning temporarily,
getting drunk often causes long term permanent changes, having a lobotomy
causes immediate permanent changes. The functioning of neural circuitry may not be affected much by a trauma at 40 years of age, while the same trauma at 1 year can have permanent catastrophic consequences.

We have several more or less blunt instruments (speech therapy, psychotherapy, drugs, etc.) to operate on what is a "continuum of plasticity in time" and we don't not even understand the precise mechanisms we are trying to affect. No wonder we argue so much!

William Rosenthal: "We are more interested in the way mind and body represent each other and interact"

This is a much more dichotomized language than I like to use, but, substantially, I have been saying the same thing. In addition I've been stressing that, to use your language, what "mind and body" are and how "they" interact with each other changes in time. "Peeling the onion" may be a bit like doing archeology.

Wednesday, February 14, 1996

The psychological dimension of stuttering

Marty Jezer pointed out that stutterers can benefit from psychological counseling, but not because there is something "abnormal" in the psychology of stutterers, rather because such a handicap will typically bring up issues that can be aided by psychological intervention. In summation he said "stuttering has a psychological dimension, but psychology isn't the cause"

Having been clearly a proponent of this view, I want to re-emphasize a major
caveat. There could be a psychological component, while language is developing, which, in concert with some inherent weakness, could help precipitate the formation of the first "organic" core. In this view, psychology could contribute to the cause, but psychological intervention could not reach down to this level and undo the problem. The reason is simply that the psychology here wasn't anything particularly abnormal, just basic survival, as Woody put it, and the organic pattern it helped form will now persist even if the psychological reactions change. Here is where there can be no sharp distinction between psychological and organic.

I know, too many "coulds" and I have beaten this horse to death lately. I will
also follow John H,'s suggestion and refrain for a while until I get to read
Perkin's book. But, even as a believer in a fundamental organic cause, I think
it is extremely important that we do not interpret this in a fatalistic manner
and simply assume that we just have to wait for a "pill". I wholeheartedly
support the work of Woody and others who feel that early intervention in
children can prevent stuttering. I've tried to show that this is not in
contradiction with an organic view. I hope I made sense. In this context I'd
like to pose a few questions.

1. What other examples are there where psychology/environment contributes to permanent physiological changes during early development? We certainly know how the *absence* of appropriate stimuli can stunt brain development.

2. Am I correct in assuming that indeed such changes could remain beyond the
reach of psychological therapy?

3. Are there any cases where such a physiological core changes in time, due,
perhaps, to aging or other factors?

Tuesday, February 13, 1996

... peeling the ONION

Here is how I see the problem. I have expressed this in the past, but maybe it's
a good time to try again:

Organic and phsycological SEEM easy to distinguish when we are adults, in the
sense that you probably couldn't look at somebody's brain wiring and tell
whether s/he is afraid of snakes. Some of us view stuttering the same way. Why
would I block when saying may name? It's obviously psychological! ... But
wait... some of us believe that something is in fact "wired wrong" or the wires
are right but not getting the right chemicals... whatever, and names or other
"tense" or "meaningful" situations are the potholes that "loosen" some
connection in our "engine" and make us stall...

So even at this level the organic/psychological distinction is not
straightforward and is in fact the source of our debate.

But where it really gets hard is at the lover developmental level. In this sense
I fully understand Woody's parenthetical "I am not yet convinced" remark with
regard to physiological predisposition. He comes from a well supported belief
that intervention while language is being developed CAN prevent stuttering. So,
assuming (as I strongly hope) he is right, is the nature of this intervention
psychological or organic? Forgive my strong words, but, at this level, the
question is stupid.

Fuzzy logic has been a breath of fresh air in engineering, because here was
finally a system that recognized that some concepts don't have well defined
boundaries, yet, it is ultimately possible to build very precise systems based
on these concepts. Psychology and organic development are probably unseparable in the first few years of life. We are not a computer on which we can load and unload software. The computer/software analogy can work to some extent in the adult brain, but certainly not in the developing brain of children. At that point in our life at least some of our experiences "become" the computer.

"Organic" doesn't mean "written in the blueprint". Our genes are not read out in the same way a factory robot might be programmed to build your car. They are simply triggers for a very complex series of events that lasts ....all of our life. Certainly the body is buisiest building up new stuff during the first 9 months... but even here some of what actually gets built depends on factors such as nourishment and even some element of chance. Why chance? Because some (most) processes do not rely on precise measurements. Chemicals are thrown in quantities to a cell, so that, on average, it will pick up what it needs. Nature relies on "the law of large numbers".

At birth the body as we know it is recognizable, but the cognitive WIRING of the brain is just getting started. The only difference between the development of the lungs in the first 6 months and the development of the brain in the first 4 years is that the brain relies on external and internal "information" inputs as well as on all the other physical stuff. If we could see a lung defect coming we could intervene "mechanically" in the fetus to prevent it. If the natural evolution of child's speech mechanism (for whatever yet unknown reason) could be recognized to be toward a stuttering "circuitry" it may be possible to intervene either organically and or environmentally to prevent it. At this
level, seemingly "psychological" intervention, could be, in fact, equivalent to performing surgery on a fetus. The final result would the same: a system that is actually "organically different" from what it would have been otherwise.

You have your hexagon, which works very well at the "higher" levels. My model is an ONION. The outer layers are strongly psychological. As you peel them away they become more and more organic and each layer has its on peculiar SYSTEM to hold it together. As adults we don't have much choice but to slowly peel away. It may be possible to intervene in children to prevent the formation of outer layers, and it may be possible at some time in the future (my strong hope) to find the very "beginning" cause, without which the onien wouldn't grow or even stay together, the grain of sand which makes the pearl grow (we like pearls, but I am sure mussels don't!).

Monday, February 12, 1996

The consequences of different views

John says that we disagree on the nature of the speech block "because each of us is talking from a different body of experience" and it may be therefore impossible to reconcile our differences.

Well, unless we are solipsists, one of us is giving a wrong interpretation to
his experience. At this point I am neither interested in "being right" nor
"agreeing to disagree" and leaving it at that. Particularly because you are so
influential in the stuttering community and command a lot of respect, it is
important that the consequences of your (and, more modestly, my) thinking be as clear and unanbiguous as possible, and, perhaps, stimulate tests and other ideas.

The consquences of a psychological etiology of stuttering (as you hold) are as
follows:

1. Figure out the psycho/emotional system that holds stuttering together (e.g.
hexagon) and you can, with time and effort, cure the problem.

2. Research in organic causes would, at best, reveal some predisposition to mild
(no blocks or prolongations) disfluency, but could not yield a cure to adult chronic stuttering.


The consequences of an organic view are as follows:

1. An organic cause for stuttering (including blocks), and, as a consequence,
the possibility of a cure, appear very likely and should be the object of
intensive research.

2. Research on the psycho/emotional system that becomes evident in stuttering
can yield to better (un)control (sorry!) of the speech mechanism in adults and,
perhaps, prevent children from learning maladptive behaviors that would further lower their "stuttering threshold".

3. Depending on the nature of the organic cause, it is plausible that it might
be affected (for better or for worse) by changes in the body, hormones (male vs
female ratios), aging (disappearing problem) etc.

I am sure there is much more, in both areas, that I am not thinking of.

Regarding the speech evolution scenarios you mention, they neither prove, nor contradict a starting organic predisposition. In the presence of a problem, the speech mechanism (micro-system) continues to evolve and to incorporate the (bad) coping mechanisms that lead to blocking. PERHAPS at this level it is possible to prevent blocking from becoming "entranched"in spite of a predisposition to do so. I guess this is what Woody would base his ideas on childhood prevention...
(right Woody?).

If this is indeed possible, then it is conceivable that somebody born with the organic predisposition to stutter might be prevented from doing so. So here is some common ground with your view.... more to follow.

Is it easier to learn maladaptive behaviors?

Winston Purdy commented that "maladaptive behaviours seem to be easier and quicker to learn than good ones"

I'm not so sure. Unfortunately, in the immediate moment, it's not usually
obvious what is maladaptive and what isn't. A consequence of a belief in an
organic origin is the possibility that, given an organic "fix" to the problem,
any maladaptive behavior would "melt away" on its own accord. The body would probably "find its own wisdom".

This is by no means sure. It is also plausible that maladaptive stuttering
behavior could have become so entrenched that we would require years of
"unlearning" even after the organic problem has been fixed. I consider this
plausible but unfortunate (because it would mask the "fix" and make it much
harder to prove). I would bet, however, on the former. I.e., given an organic
fix, any maladaptive learning would prove to be very tame.

In mathematical terms, the organic problem is like a "forcing function" that
causes the permanence of the maladaptive behavior. We can, in hindsight,
recognize maladaptive behavior and work on creating a new transformation that is able to reduce the effect of the forcing function, but there is no guarantee
that this will work for everybody (the forcing functions may be different).
Unfortunately this is the ONLY course of action we have available and I, for
one, wouldn't sit around waiting for an organic fix (and I haven't).

Anyhow, my main message is: We learn maladptive behaviors not because they are somehow easier than "good" ones, but because they are an immediate consequence of some real underlying problem. We put our hands in front of our face because we keep falling. Yes, putting our hands in front of our face makes us fall even more, so we can spend years in self- or other therapy to learn how to keep our hands at our sides and accept the occasional bump in the head, and that's fine, I agree that that's a better strategy, but, if you could just eliminate the underlying reason for falling, then your arms would find their way to your sides very naturally and with no need for great revelations. That's my bet.

Friday, February 09, 1996

J. Harrison's "bobulating" and organic causes

Fine word, but John, I'm gonna say something I've been meaning to say for a
while ... it really confuses the issue. This is why. I feel it gives you a way
to "partially agree" when in reality your disagreement is more profound (and so be it). When you divide up stuttering into behaviors fluent people experience, such as bobulating, and those of stutterers, such as blocking, it allows you to say "some stuttering (i.e. the bobulating part) can be organic in origin", but that doesn't amount to much.

The fact that some people may have more of a predisposition to "become discombobulated" when tense, doesn't interest me any more than saying that some people have a tendency to blush or sweat more than others. When I (and probably most others) debate on the etiology of stuttering, I include "ssssssssssan Francisco" as well as silent blocks as THE essential part of the phenomenon.

So let's call spade a spade. You believe that stuttering is essentially a psychological problem. It's OK. You are not the only one. But it is important to note that when people present evidence for organic causes they are talking about Stutering (capital S), not bobulating.

John says that there is no "need to resort to a mysterious genetic predisposition to explain why a block occurs".

You can probably dissect any particular block and find some reasons why that block, in particular, happened, but I believe that the general tendency to block requires an organic explanation. It's like having a car that stalls a lot. Any particular stalling event might have an explanation of "no spark" or "not enough gas" but the real underlying cause is a badly designed ignition system. There are SYTEMS at this level as well at the level you usually refer to.

John thinks that blocks can be explained as "a programmed, habituated response".

I agree that some of blocking behavior is reinforced by a programmed, habituated response, but what gets habituated is the fear and probably accompanying maladaptive behaviors, such as tensing up. We also agree that we can work at changing the program (and we both have, in ways that seem dissimilar, but are really not) Where we don't agree is that I (and others) think that

1. Blocking behavior (i.e. Stuttering) could only get started and become established enough to begin creating secondary reactions (fear etc.) because of organic reasons The above explanation accounts for its getting a firm hold of our speech system, and even making the problem a lot worse.
2. An "unlearning" process for "un"monitoring and "un"controlling your speech, while almost always helpful, will not necessarily lead to the complete elimination of Stuttering.

My own personal suspicion, is that, in fact, we may have not been as responsible for our "cure" as we think we are. "Organic" doesn't mean perennial. Our body changes and, by the time we find our way back from our maladaptive behaviors, we find the organic core isn't really a big deal any more, or that it's gone altogether. Alternatively, we may find that the organic core continues to overwhelm the speech system and no amount of "unlearning" will do the trick. Basically this is how I explain both your success and mine (more moderate) as well as as the difficulties others seem to keep having.


John claims that being aware of the particular circumstances of any particular block allows him to "let go" and can't understand why we are odds about this... (hence his belief in a psychological root to blocking)

We are at odds partly because I came to the same ultimate conclusion (let go,
zen, etc.) precisely by NOT analyzing my blocks and NOT even considering any
approach avoidance issues, but by taking a holistic view immediately). Any rare
residual blocks I have are complete surprises and appear to me completely
devoid of psychological loading (in the past you have asked how I can be so
sure... I guess I just am... that's the best I can do).


John feels that the incidence of stuttering in some families can be due to other common family circumstances rather than genetics... (the old "nature vs. nurture debate").

If I didn't believe in an organic cause, that's how'd I'd try to explain it too,
but my impression (somebody correct me) is that genetic connections are drawn beyond the immediate family. Aren't there studies about twins raised in
different families too (somebody help)? My stuttering relatives were a cousin
(now in his 60s and still stuttering) and an uncle, now in his 70s, whom I
actually never heard stutter, but who told me he did as a young man (he, by the
way, never claimed any particular insight or effort ... it just went away).
Both people are from my mother's side of the family. All families were quite
different as far as I know.

Thursday, February 08, 1996

habits/organic predisposition

John Harrison commented that it was hard for him to understand how locking his vocal cords in a three second block could be organic. Same point for prolongation of a sound like "s" in Sssssssssssssssssssssan Francisco...

I have a hard time understanding how it might NOT be! But I fear we are like the blind wise people who are surrounding an elephant and are trying to determine what it is....It's a snake! ...It's a tree!

However John also commented that talking quickly and rising emotions could bring out genetic issues as different people react differently to stress and such "interference" could "end up in stumbling-like disfluencies".

I was about to say that I agreed until I realized you were edging with a "slight of definition". It seems to me that your "stumbling-like disfluencies" are meant to exclude blocks. To me they are a primary and far more important sympton of an organic problem than "stumbling-like disfluencies" (what you used to call "bobulating"?).

In the past we have worked hard at finding commonality in our thinking, and we have, but we are good friends enough that it's entirely OK if we don't agree. I think it would actually be more useful now to really stress where where we do not agree. I know we beat the "origin of block" to death a while back, but it might be worth a rehash.

Bad habits and organic predisposition

A (sarcastic) question was posed as to whether an "organically predisposed alcoholic"
would be "predisposed to recognize Jack Daniels and Jim Beam"....

No, what I am saying is that his body processes alcohol differently from mine.
I can drink a glass of wine and not feel drunk nor feel an overwhelming desire
to keep drinking. I'm no expert on alcoholism but it is entirely plausible that
some enzymes that break down alcohol for me are lacking in the other fellow and
that alcohol goes to his brain in greater quantities and much faster.

It is entirely plausible that "stress" produces some chemical that affects our
speech apparatus. Fluent speakers are organically more fit to deal with that
chemical (just an example of what "organic" might mean, unfortunately no
specific mechanism has been proven yet).

Comment: To become alcoholic one needs first to make the choice to start drinking. One cannot possibly be "predisposed" to making that choice.

The predisposition is not in the choice itself (unless later he becomes, as he
well may, less "free" to choose) but simply in what happens as a consequence of
the choice. Suppose a bird is born with only one wing and sees all its siblings
jump off their nest and fly away. Of course it would choose to try and fly off
as well, with obvious dire consequences.

We are more like the bird than the alcoholic. We don't really have a choice not
to talk.


Can the "organic" weakness be in the lack of will power rather than in the system?

People have been blamed throughout history for being "weak" ... just stop eating!.... just think happy thoughts! ... I fear, as stutterers, we have no immunity against this sort as weakness as well. Yes, I could be a PWS and be unwilling to face the issue. It is also absolutely true that extra will power and desire can go a long way towards making stuttering a non-problem, as many of us bear witness to. But it remains EXTREMELY important to know exactly what we are dealing with.

We find now that people may have a weight "set point" just like we have a set
body temperature. Yes, if you don't eat you lose weight, but for some people it
may be sheer hell, for others no big deal. I can tell you that stuttering is no
longer an issue for me, and how I've done it. But, I simply don't know if my
effort is equivalent to yours. I don't know if your speech "set point" is
different from mine

A quote from the movie "12 Monkeys": "There is no right or wrong, just popular opinion."

No, there is observation and good science.

1. Is it plausible that an organic problem could cause stuttering? -Yes
2. Is there any data in support of this hypothesis? -Yes (genetic studies)
- much more coming in from scans etc.
3. Has a specific mechanism been demonstrated yet? - No
4. Is it plausible that the problem is compounded by psychological factors? -Yes
5. Do we need to work in all of these areas? - Yes
(I'm sure people will quibble here and there, but I doubt that we can steer away
too much from these basic facts).

Saturday, February 03, 1996

Questions on "organic predisposition"

Is there a predisposition specifically for stuttering or for the system that supports it?

There is system and there is system.. What you call "act" is in the fact the
result of a very complex control system that transforms your thoughts into that
very complex sequence of articulations that produce the sounds we call speech.
I, and probably most of those who think in terms of predisposition, see a
likely weakness in this system. BUT, this doesn't exclude the importance of the
LARGER SYSTEM, which includes fears, bad habits etc. This larger system can
make it very hard to get to the bottom of the problem, but this is the system
can can be undoubtedly modified (in fact it MUST be). Here I agree with John H.

Is there also an organic predisposition for other "habits"?

We stutterers have other habits too. Drinking, smoking (and some good ones too) etc. come to mind as possibilities. I, for one, don't think they compare at all with stuttering. Somebody can probably bring some statistics to bear, but I think that will and support (e.g. 12 steps programs) can, in fact break many habits in a way no stuttering therapy has. Now, there are certainly aspects of what we label stuttering that include "habits". Looking away while blocking, closing one's eyes, twitching, whatever.... come to mind, and these can in fact be eliminated the way unwanted habits can.

Can we be organically predisposed to some habits? Some people think this is the case for alcoholism, for example, and there is much talk about "addictive personalities", but, again, I suspect that whatever organic weaknesses make one prone to drinking, smoking, overeating, depression are different from each other, and different from whatever causes stuttering. The trend seems to be that more and more of what we used to view as (controllable) bad habits have in fact some organic origin.

Comment: everybody seems to be coming from different stuttering paradigms

Actually they seem to be only two: genetic/organic and psychological (bad habit,
just say no.. etc.). But of course there are all kinds of shades in between. The problem is really that the two are not mutually exclusive and it's very hard to sort out the relative weights of both in the "full blown" manifestation of stuttering. I suspect that these relative weights are different for each stutterer, which leads to the differences in perception we often seem to display.

Thursday, February 01, 1996

Stuttering as a "limit cycle"

John Harrison responded to my remark" "we pay attention because we stutter rather than the other way around..." by stating that it wasn't an "either-or" situation.

It is either-or in the following sense: we must not confuse the "final" manifestation of a problem with its origins. It's simple misfortune that "paying undue attention" tends in fact to make the problem worse. If paying attention helped, stuttering would probably be nipped in the bud immediately. We'd have a mathematically stable system stutter-payAttention-stutterLess, just like a ball at the bottom of a cup, you move it and gravity pushes it back to the bottom.

Unfortunately the system is unstable: stutter-payAttention-stutterMore-payMoreAttention...
Eventually we get trapped in a "limit cycle" (sorry about the math...) and we lose track of how we got there.

The "chicken and egg" problem is not a conundrum, it is a hystorical artifact. If you could reconstruct evolution precisely you'd find "what" came first (neither the chicken nor the egg).

I agree with you that the final manifestation of stuttering is an interlocked system, and that, yes, learning to "pay less attention", more zen, whatever... has the positive effect of releasing us from the tighly locked cycle that can make stuttering much worse.

I simply want to make sure that nobody gets the illusion that unlocking or "melting away" the cycle automatically makes us non-stutterers. I know, you probably want to say "it depends on what you mean by stuttering...". I'll preempt you. I mean that, when all is said and done and we have achieved the highest zen mastery, at least some of us, will still be prone to blocking once in a while. There will still be a fundamental "organic" difference between us and fluent folks.

I don't want to sound defeatist. Unlocking the cycle is precisely what I have worked on and I consider myself "recovered" in the sense that stuttering has ceased to be an issue in my life. I just don't want us to lose sight of the fact that we are dealing with a real organic problem as opposed to some chance "psychodynamic event" whose consequences can be undone with the right attitude.

I keep having the nagging feeling, I have often expressed, that we are talking about apples and oranges. Could it be that the there are vast differences in the "original" organic problems we have? Could it be that the final "system" manifestations of these problems are, instead, fairly similar? After all, whether we trip on a pebble or a rock our fall is going to look remarkably similar!

So people like you would say "if you melt away the cycle you've got nothing left!" (and indeed I've never heard you stutter). I say "I've got nothing left that I really worry about.." ( but I still experience some occasional "surprise" stumble..), and others will say "you guys are full of it...I worked and worked and I keep falling back into the same patterns!"

How I hope we'll figure it out some day!

Wednesday, January 31, 1996

"Paying attention" to our speech

In answer to a comment about the need to *not * to pay attention to our speech in order to be fluent...

I'd say yes and no. Yes, of course, and that's precisely how we learn to speak
in the first place! We all experience long beautiful stretches of fluency.
That's also how we learn to sing, dance and recite acting parts... but ...
there is "something else" going on here that can challenge any zen master. To
use John's downhill skiing example, it's as if the mountain suddenly became
alive and sprang a mogul right in our path. Or, in Viki's piano example, as if
your finger suddenly became paralized on a passage you know extremely well.

The implication is often made that it is precisely the effort to control that
causes these stumbling blocks. While it is certainly true that focusing on the
lowest levels of detail of any motor skill causes problems I DON'T THINK this
is the fundamental cause of stuttering.

We pay undue attention to where we are going BECAUSE we are prone to falling. We ARE NOT prone to falling because we pay undue attention to where we are going!!!

Now, I have found that I can act internally to keep the mountain from becoming
"alive" and springing huge moguls in my path. Only small ones seem to appear
unexpectedly these days and I can usually handle them. If I find that they are growing in size I stop, take a breather, wait a few seconds for the mountain to calm down, then I start down the mountain again. This form of "monitoring" (or control) focuses not on what I am doing (words, breathing, sillables, whatever...) rather on how my whole body is feeling. In time this process has become less and less "conscious",... yes, more zen-like.

Again, the zen part is not in ignoring how I am turning on those skis - I was already very good at ignoring it, and still I fell... -, rather in tapping into some additional skills fluent folks can simply ignore. I have no idea how this translates biologically. Am I training new speech pathways? Am I producing extra amounts of some brain chemical? Whatever it is, I am firmly convinced it's not as trivial as learning to formulate speech without "paying attention" to it. I'll say it one more time: We pay attention BECAUSE WE STUTTER - We don't stutter BECAUSE WE PAY ATTENTION.

Friday, January 26, 1996

Stuttering and Toastmasters International

I've been a member of TI for about 8 years. Even though specific speeches are aimed at different skills, such as "using your body", "voice variety" etc., the choic of
topics is completely fee, so it's easy to weave in information about stuttering at
any time. In one speech I used a HUGE block at the very beginning as an "attention getter". It was a fake, but did it get their attention! The rest of the speech was
about stuttering. It was a great opportunity not only to explain how I deal with stuttering, but also to make recommendations they could apply to their acquaintances and loved ones.

The important thing to remember is that fluency is only ONE of the "skills" that make one a good public speaker or communicator, and it is not the skill TI focuses on, so it's not a substitute for therapy or for a support group such as NSP. It's wise and fair to let the club know that some prolonged "pauses" might not be a dramatic choice for our speech, and that some repetitions may not be under our control,... but, beyond that, there is plenty of room for the kind of constructive evaluation that everyone gets in the club.

I have no doubt that, at least in a large number of cases, a stutterer can become a BETTER speaker than a non stutterer. Better in the sense that a listener would rather hear and see her or him than another, fluent but boring, speaker, but isn't this what really matters?

Of course increased confidence in public speaking also had the welcome side-effect of decreasing tension and increasing my ability to "control" my stuttering. This reinforces the general "strategy" I have often advocated to get at stuttering in indirect ways. Examples I have mentioned in the past are training in dance, singing, martial arts etc.

Monday, January 22, 1996

Speech hesitations in foreign languages

It's an interesting question, but, coming from a biligual
(English/Italian-native) stutterer, I would say that both the nature and intensity of the hesitations experienced in trying to speak a new language have very little, if anything, in common with those of stuttering. Foreign language hesitations appear simply cognitive in nature, those of stuttering seem to come "from somwhere else" and "feel" uncontrollable. Trying very hard to speak a foreign language DOES end up in more and more fluent speech. The opposite can happen with stuttering ("trying" hard can have the opposite effect). There absolutely nothing comparable to stuttering blocks in learning to speak a foreign language.

What could be an interesting research area (and it has been discussed on and off on this list) is how different levels of fluency (in a language sense) affect fluency in a stuttering sense (I wish we had different words to express the two notions), i.e. how stutterers perform as they reach different levels of foreign language ability. My subjective impression was that I actually stuttered LESS while I was in the beginning stages of learning English.