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?