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...
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