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.

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