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

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!