Stuttering

Fear is not a fundamental cause of blocking

1997-01-13T00:25:00.000-08:00

From: Winston Purdy
...
>So I agree with Richard H. that the blockage takes place in the brain as a
>result of a (very real) fear that the speech mechanism won't work
...

I don't want to put words in Richard's mouth, but, since so far I have agreed with everything Richard says, I assume we have the same mental "model". At any rate, according to "mine", yes, blocks occur "in the brain" but no, NOT NECESSARILY as a result of fear. Fear certainly contributes to whatever factors trigger blocks, but its absence is no guarantee of fluency. I say this from personal experience. I have long eliminated all concerns about stuttering on any words but an occasional block still manages to catch me by surprise. NONE is a result of any fear or "expectation" on my part.

Elimination of fear will invariably result in fluency improvement, and, for this reason, it's an essential element of any therapy, BUT, if we are looking for fundamental causes of stuttering, it's a red herring, IMO.

Computer models of the brain

1996-10-23T00:10:00.000-07:00

> 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.

Onset and ending of "Sudden Fluency"

1996-10-17T22:51:00.000-07:00

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!

More on the radical neurological position

1996-10-16T22:16:00.000-07:00

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.

Issues with a "single theory" of stuttering

1996-10-15T22:29:00.000-07:00

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.

Biological "set points"

1996-10-10T21:48:00.000-07:00

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...
________________________________________________________________________

The radical neurological view

1996-10-09T23:40:00.000-07:00

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

1996-10-09T23:30:00.000-07:00

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

1996-10-09T23:15:00.000-07:00

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.

Usefulness of brain scans

1996-10-08T00:03:00.000-07:00

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).

More on "Mysterious blocks" #2

1996-07-09T21:26:00.000-07:00

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!

More on "mysterious blocks"

1996-07-03T23:26:00.000-07:00

(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?

More on stuttering as "inappropriate control"

1996-06-24T22:42:00.000-07:00

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.

Stuttering "because" of (unneeded) conscious control?

1996-06-21T21:36:00.000-07:00

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.

Stuttering in children of PWS's

1996-06-19T22:52:00.000-07:00

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.

Stuttering and a career in science

1996-05-15T22:37:00.000-07:00

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.

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

1996-05-06T23:47:00.000-07:00

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

1996-05-06T23:22:00.000-07:00

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.

Stuttering and "loud" cultures

1996-05-02T22:59:00.000-07:00

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,

Fluency: When is enough enough?

1996-04-30T23:39:00.000-07:00

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.

Rewiring neurological pathways

1996-04-26T14:38:00.000-07:00

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.

"Conquering" stuttering (and fear of the phone)

1996-04-01T23:30:00.000-08:00

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)

Different causes for different people?

1996-02-16T12:15:00.000-08:00

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.

A Mind-Body dichotomy?

1996-02-15T11:46:00.000-08:00

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.

The psychological dimension of stuttering

1996-02-14T20:57:00.000-08:00

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?

... peeling the ONION

1996-02-13T20:35:00.000-08:00

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!).

The consequences of different views

1996-02-12T21:27:00.000-08:00

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?

1996-02-12T21:12:00.000-08:00

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.

J. Harrison's "bobulating" and organic causes

1996-02-09T20:36:00.000-08:00

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.

habits/organic predisposition

1996-02-08T23:36:00.000-08:00

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

1996-02-08T22:05:00.000-08:00

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).

Questions on "organic predisposition"

1996-02-03T22:37:00.000-08:00

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.

Stuttering as a "limit cycle"

1996-02-01T21:03:00.000-08:00

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!

"Paying attention" to our speech

1996-01-31T20:47:00.000-08:00

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.

Stuttering and Toastmasters International

1996-01-26T20:38:00.000-08:00

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.

Speech hesitations in foreign languages

1996-01-22T23:49:00.000-08:00

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.

Comments on a Parents' Manual

1995-12-11T00:04:00.000-08:00

In response to a Parent Manual that characterizes stuttering as an "awful" problem

My main point is that it doesn't lay the groundwork for the "acceptance"
part. The old dichotomy "accept but work on changing..." is probably
good for parents as well. In spite of your splendid results there is
still the chance it will become chronic and both parents and child will
have to live with it. I agree this stage is not the right time to tell
them it wouldn't be the end of the world, but it may be the case that
some appropropriate euphemism might do more than just allay sensibilities.

Something like "a problem whose lifelong challege cannot be underestimated"
... a mouthful but sort of the idea. Has John Alhbach seen this? I'd be
curious of his reaction, given his fundamental acceptance position.

Interestingly, and in support of your present writing, my wife loves your
pamphlet as well, and has said nothing about the "awful" characterization.
I am sure she agrees (as deep down I do too...). So, it's worth a thought,
but certainly not much worry. It just leaped out at me and I thought I
should mention it. The important thing is to help the children, and help
the parents help the children, as you are doing so well.

More on SLPs

1995-11-22T23:55:00.000-08:00

I just want to make sure my posting is not misunderstood. IN NO WAY do I mean to imply
that SLPs are not in the best position to become stuttering therapists,
should they wish to do so (as most or all SLPs on this list obviously have).
They are probably also in the best position to diagnose speech problems.
The way I'd like to frame the discussion is "is there room for some who
are *exclusively* stuttering specialists", probably with an overlapping
but different background, and "how do we (both PWS and SLP) guard against
malpractice from both these hypothetical specialists and SLPs that choose
to treat stuttering.

To use an analogy, civil engineers are certainly best suited to become
good architects, yet, while overlapping, an architect's background
focuses on different aspects of construction. Good construction inevitably
requires BOTH sets of skills. Both professions have bodies that guard
both ethics and quality. A good architect also knows when to send
a client to an engineer and vice-versa.

Questions about the SLP profession

1995-11-21T23:43:00.000-08:00

We talked about a stuttering specialization for SLPs. Now I want to ask
something that is bound to generate some heat ... can one become
a "stuttering specialist" WITHOUT becoming first an SLP? I am
interested in both issues of potential effectiveness as well as legality and
peer recognition.

First of all, I believe that there are already people in the profession
who are not SLPs and some are well known (am I right?). Whether or not
they are well regarded by SLPs is not the issue (or is it?). I simply wonder
whether it is really necessary to learn about other speech and hearing
impediments in order to become an effective stuttering therapist.

My reasons for asking are both "academic" and personal. On the academic side
is my belief that stuttering is fundamentally different from, say, aphasia,
and, as I expressed in other posts, studying neurology and psychology might
be actually more relevant to the stuttering problem. My personal reason
is simply that I have given thought to becoming a therapist but I am
exclusively interested in stuttering. Yes, one can pay "one's dues", but,
as anyone at my stage in life will attest, I feel I have already spent
most of my life "paying dues" and, at 50, I have very little patience
for dealing with stuff that doesn't go right to the core of what interests
me.

Granting that, to some extent, we always bring all of our background to bear in all our endeavors, how much of a typical SLP's academic and (non-stuttering)
therapy background REALLY comes to bear on stuttering therapy? How much
is "paying dues" (if you are only interested in stuttering)?

Blocking and the "Valsalva maneuver"

1995-11-21T23:33:00.000-08:00

(In objection to blocking being caused by a stoppage of air-flow)

I once heard Bill's (Bill Parry) presentation. I was and still remain skeptical.
To me the "block" is in the "control system" that moves the
articulation along from one phoneme to another. It doesn't come
from "cutting off air". To use an analogy, suppose I am playing the
saxophone. One could stop me from going on with the music simply by plugging
up the air duct (Valsalva, if I understand correctly) or by paralizing my
fingers. But wouldn't sound still come out if I kept blowing with my
fingers paralized? That's where the analogy breaks down. In the case of speech,
"finger movement" would feed back (my educated guess) and determine how
much blowing is being done. So the whole system comes to a grinding halt,
but NOT because something just plugged up the air duct. I realize this
is mere speculation, and I am not sure if any therapeutic consequences
would come out of this, but it would be great to devise and experiment that
puts the issue to rest.

There is actually an observation that, IMO, puts the issue to rest. Some
blocks come with "sound" behind them! Unless I am dreaming, I have often heard
stuff like hmmmmmmmmm, hmmmmmmm, hmmmmmmPOLICY, for someone blocking
on the "P" of "policy". So air is actually flowing, just like it would be
for the "finger paralized" sax player.

I have pointed this out a few times on the list and never got an answer.
Will somebody please either agree with me or tell me why I am wrong?

One last point. I do NOT mean to carry the analogy to imply that some
form of vocal cord "paralysis" is the fundamental cause. Again it's the
sequence of articulatory commands from the brain that gets "stuck"
(my opinion and that of many).

Stuttering in a foreign language

1995-11-20T22:26:00.000-08:00

In this post I was asked several interesting questions by Larry Molt. I will paraphrase his questions and post my answers

Yes, even though initially I was not recognized as a stutter I did experience stuttering exactly the same way I experienced it in Italian.

Yes, I experienced the same stuttering patterns (block etc.)

No, stuttering did not happen to the same extent as in Italian and it also went unrecognized because it was misinterpreted as a difficulty in speaking a foreign language. As you conjectured, I was also speaking slower, with shorter phrases, more pauses etc. probably reducing demand on my speech and therefore reducing stuttering.

Eventually the reason for lessened stuttering vanished with increasing "fluency" (yes, I was struck by the same conundrum!... more stutter the more "fluency" in the new language). Interestingly the first statement is true to this day. In my mind English, at this point, is actually easier than my native language, but I still do have a slight accent, and when I have one of my now rare blocks, people tend to think that "I'm hunting for the word". Given different situations I've had to choose between being thought of as
"just off the boat" or as a stutterer..

I think my experience does match yours (ironically, stuttering more with increased "fluency" in the foreign language). Interestingly it was also confirmed
in an acting class I took. As I was learning a part, I was better able to
avoid stuttering than when I had completely "interiorised it" and had begun
"being" the character I was portraying. The director asked me why I had chosen
to "make" the character stutter! He was baffled when I told him it had not
been an "acting" choice.

Is my child a stutterer?

1995-11-20T12:29:00.000-08:00

Hi Woody,

My 3 1/2 year old child, is beginning to show occasional signs of "stuttering"
that go a bit beyond "normal" hesitations for that age. I am not overly
worried and he has shown no signs of frustration. He LOVES to talk and
his chatter is incessant and quite fun to hear. In the past I would have
just waited, but, given the information you have put on the list, I do
view him as "at risk" and I would like to have him undergo whatever
therapy might be appropriate at this point.

Is there any clinic/SPL in the San Francisco Bay Area, that would approach
this type of therapy along the lines you have been developing?

I'll appreciate any suggestions.

Stuttering in biligual children

1995-11-16T12:34:00.000-08:00

Does the "capacity and demands" model imply a higher incidence of stuttering in bilingual children?

I am betting my own child's life experience on "no"! I think "demand"
refers to "speech mechanics" performance, not a knowledge of alternative
ways to say things. He is simply learning that mother says "milk" and
"papa'" says "latte", so when he talk to me he asks for "latte".

If I can use an analogy, would you worry about cognitive overload if you had
a vacation house and you child had to learn to find his way around two houses
instead of one? He would learn that the kitchen is on the left in house A and
on the right is house B. "Demand" would be equivalent to asking him/her to
move faster in either house...

I sure hope I am right...!

Why I joined the NSP

1995-11-15T23:46:00.000-08:00

Ira Zimmerman commented that people who have largely overcome stuttering should perhaps form a separate organization (NSP stood for National Stuttering Project - the name was later changed to NSA)

granted that one could claim that "everything" we do is to meet some
need... I joined the NSP more to see if I could help than to find
"support" for a problem I felt I had largely overcome. Maybe this
was presumptious on my part, but it was my original motivation. It
turned out that I still received much more than I gave. Some of
what I received can be described as follows:
1. A sense of "coming home", embracing where I had been. Note that
until then I had always avoided other stutterers...! Interestingly I
had fully accepted (or so I thought) MY stuttering, but hearing others
stutter brought back too much pain... until I joined the NSP. This
was perhaps one more phase of healing I didn't know I needed.
2. Absolutely wonderful new friends. People like John Ahlbach and John
Harrison! And many others.... I see them rarely now, but when
I do it's like meeting family.
3. New and continuing insights on stuttering. Some that I am still
applying to myself, and some I can share with others (including
this list). On and off I toy with the idea of becoming a Stuttering
Therapist.
4. Surely much more than I am aware of.

"If you stutter you are not alone" is the NSP motto. I did grow up
"alone" and I wish I hadn't. The stuttering of each one of us takes
different paths, but none of us has to face it alone, ever again. I thought
I'd join to give support and embrace those who were still
struggling. It turns out that I embraced my "child" and that everyone
embraced me. Are you still puzzled Ira?

Bilingual stutterers

1995-11-15T00:10:00.000-08:00

In response to a comment about the possible deleterious effect of bilingualism on suttering

I am a bilingual stutterer, and now father of a child I am encouraging to
become bilingual.

I was born in Italy and came to the US at 16 for one year, then again
at 20. At first I was not recognized as a stutterer in this country, but,
as I became better and better in English stuttering became evident
again. What I think happened is very simple: my hesitations in a foreign
language simply masked my stuttering. I must confess that for a while
I found this very convenient... it was much better to be thought of as
foreign struggling with english than as a stutterer!

I have also felt that Italian requires somewhat faster vocalization for
the same rate of speech, as words are generally a bit longer, so I retained
the feeling that I stuttered a little less in English. This observation is
however clouded by the fact that I have worked at overcoming
stuttering and I no longer view it as a problem in my life. The same
might have happened if I had stayed in Italy.

I am the father of a three year old, whom I consider "at risk" for
stuttering.nevertheless I decided to speak to him only in Italian. He hears
English from everyone else. I don't view this as extra potentially
deleterious "pressure". To him it's just an alternative way to say things and he seems
to be enjoying it.

Specializing in stuttering therapy

1995-11-13T23:19:00.000-08:00

To a therapist claiming that it's not "good" to simply specialize in stuttering (he'd rather work on a broad range of speech problems).

Why not if it DOES work? There is something to be gained from "holistic"
approaches, in fact MUCH to be gained, when the areas considered have a
fundamental bearing on each other. The "specialist" in stuttering might
well have to be a generalist in neurology, psychology, phonology etc.

I feel that sometimes we are stuck with classifications that are based
on old fundamental misunderstandings about problems. The appropriatedness
of classifying stuttering with many other phonation problems should be
revisited in light of what we are beginning to understand.

Please note that I speak as a stutterer, not a SLP, and I have no specific
knowledge to make me doubt that you have personally been very successful in
working with stutterers. I can only say that, as a consumer, and given
the simple fact that so much therapy is ultimately unsuccessful, I would feel
much more comfortable knowing that my therapist or my son's therapist is
totally focused on, and knowledgeable in, the peculiarities of this stubborn
problem.

The scientific value of testimonials

1995-11-09T23:12:00.000-08:00

In response to a comment by Ira Zimmerman stating that there is no scientific backing for most claims of "recovery".

I am one of those people who tends to talk about stuttering as *mainly* a thing
of the past, and has given "testimonials" on his recovery process. I think
both Ira and Jason bring up good points.

The fact is, I DON'T know if I got better because of my efforts, or aging
would have done it for me anyhow. I DON't know if what I have been doing would
have been equally successful had I started off with much more severe
stuttering. When I talk about my "success" I can't help having a nagging
feeling that, in spite of what I think, my problem and, say, Ira's, were
quite different. My very first contribution to this list was in fact
a thread that dealt with the possibility of two different "kinds" of stuttering
(I mean both recognized as developmental but arising from different
causes, although "appearing" to be the same problem on a continuous severity
scale). I even asked if there were bimodal distributions on any stuttering
"metrics".

The best answer I got was Woody's, who stated that, in his experience, "severe"
stutterers often seemed to make rapid progress in therapy, only to relapse,
while "mild" stutterers made much slower but stable progress. I think there is
something really worth looking at here....

All this being said, I, John and others are simply data points. If somebody
claimed to have improved by making back-flips, that would be a data point
too. It's up to whomever wants or can to use these data points and make
some rigorous science out of it. So, no, my own testimony IS NOT GOOD ENOUGH,
but together with that of others it may enable some useful model to be built.

I really wish I could have been part of a rigorous test. If anybody thinks that
they can do something with me now... come and take me, I'm yours!

Thank you, Ira, for reminding us that just because we say it is.. it doesn't
make it so.

The brain and the hardware/software analogy

1995-11-08T23:38:00.000-08:00

I just want to make the point that the hardware/software analogy with
some kind of "fixed" brain on which some kind of "programming" (presumably
environmental/psychological) is imposed, is VERY limited and perhaps even
misleading when it comes to language development.

First of all, when it comes to neural nets, both biological and artificial (my
field) program and hardware cannot be separated. The "program", which can only
be defined as interaction with the outside world, becomes inextricably connected with the hardware. In a regular computer you could erase the program, and the
hardware would remain, unchanged, and ready for a different program. Even with
the very simple neural nets we build, it is not possible to separate the two.
Changing the program means modifying the connection strengths between neurons
AND adding or eliminating neurons and connections. So what are we changing, the
software or the hardware?

Second, the way this kind of "programming" is realized in the brain is itself
the result of "primitive hardware", it therefore not immune from the results of genetic coding. Early hardware + early interactions become new hardware, which
then becomes sensitive to new interactions (...a different level of "programming").. and so on.

I often stand in awe on how similar we all are in light of the extraordinary
complexity of our development. The point is that evolution has built a very
robust system, capable of building two eyes, two legs, a single nose etc. under
an extremely varied set of conditions. The same goes for our speech apparatus, a far more complex system than any single organ. I am baffled at the resistance
I keep seeing re-emerge to the notion that some "organically" based process
within this system might not be up to snuff. Even ignoring the abundance of
genetic studies that show a clear link (but why ignore it?), it is the amazing
specifity of the problem (even though each one of us "dances" around it in
different ways) that convinces me of a fundamental organic cause.

I am equally convinced that psychology DOES play a role. Faced with an obvious
problem, we try to overcome it or work around it. Our particular psychological
makeup can either help us or make things worse. Fear, self-confidence,
determination, acceptance, all play a role in how, if ever, we are able to
CONTINUE the kind of "programming" I discussed above. Even though our neural
pathways, at least at the level of basic systems constructed early on, are far
less plastic, we still CAN improve. Stuttering has ceased being an issue for me. I don't know if my early pathways have been modified, or if I built some good
workarounds, or if that unwelcome continuing program called "aging" had in
store some relief for me anyhow. I do know that I have worked at it, and that
my particular psychology has helped, but I might have done better sooner if
somebody had given it a little push once in a while.

Learned behaviors and evolution

1995-11-08T23:03:00.000-08:00

In response to a note remarking that learned behaviors (such as acquired musical skills or maladaptive stuttering behaviors) could be passed on by evolution.

I haven't read "The beak of the Finch", but I do know that Darwinian evolution
does NOT allow for such a mechanism. This was precisely the debate between
the Darwinians and the Lamarkians (sp?). The former explaining evolution via
chance occurrences the latter as guided by environmental "drive" or "need".
A mechanism for the former was found (the genetic system) but not for the
latter (still, I believe). But this does NOT mean that it is conceptually
impossible. We are, after all, the result of evolution, and we are now doing
precisely that, when we do genetic engineering. The point is that we are now
able to figure out, at least in a few cases, what genetic changes are required
in order to produce desired results. It is very difficult to imagine how
nature could do that simply at the level of the body i.e. without the
social/scientific evolution that allows for our ability to build "models" of the genetic system.

Computer "do" that only in the sense that the programmer knows (or should
know) how to change the code in order to obtain desired effects, but even
they often find it hard to do (ever heard of bugs?). In terms of neural nets
or artificial systems that learn and evolve without conventional programmer's
help, the ability to combine both kinds of evolution (chance and goal direction)
is an open area of research (one I am involved in, by the way).

Maintaining eye contact during blocks

1995-08-14T00:08:00.000-07:00

Victoria Schutter said that one would have to be "psychotic" to maintain eye contact during a block.

I agree with these sentiments. The first fight (amicable) I had with a SLP was about this issue. I WORRY about my listener when I have a block. They already have to put up with my inability to say a word (while resisting the temptation to finish it or guess it..) and now they have to put up with my unwavering stare that says "I know I am having a block, but I dealing with it and I want you to STAY with me". I say, give them (and yourself) and break!

So my listener gets tense... guess what that does to MY tension. Eye contact is part of the communication process and should be approached (IMHO) in the same relaxed fashion as the rest of speech. Let it be a byproduct of increased comfort, not another THING to do. Be aware of both looking and not looking and let both happen naturally. If it feels right to avert your eyes and let your listener "relax" do it. If your listener shows no sign of discomfort and seems more intererested in what you are saying than how you are saying it, then by all means maintain a natural eye contact. The basic problem is that eye contact for the duration of a serious block is no longer "natural" eye contact. I fear that it appears as "disfunctional" as the block itself - that is how it appears to me on the other side..- and it may in fact make the block seem even worse. As would of course shutting your eyes, repeated blinking etc.

This is one more case where there is no easy answer or recipe in stuttering, just the usual apparent contradictions we all have to sort out for ourselves (with the understanding help of SLPs)... accept in order to improve..., maintain control so you won't have to keep maintaing control... and so on.

"Critical Thinking"

1995-08-07T23:37:00.000-07:00

In response to Michael Sylvester after his note on 8 "critical thinking skills" directed at another post

I would add to these the need to

9. Avoid diversionary tactics such as
- banter
- trivialization of others' point ("Stuttering Kaleidoscope", "Neurological
Talk Soup", "Neurological VOODOO")
- "teaching how to think"
- Picking and choosing minor points to answer while ignoring the main ones

10. Retain a sense of common purpose and seek points of agreement as well as
disagreement.

I have found myself growing more and more impatient at your postings for the
abundance of both #9 and #10 tendencies. I found myself spending a great
deal of time for thoughtful answers, questions and attempts to validate your
experience as a PWS who has made a great deal of progress, only to see
minor points picked up and potential conclusions obfuscated by banter.

I was particularly disappointed in seeing no clear answer to my posting
where I tried to establish some commonality between your experience
and that of myself, John Harrison, and probably that of many other
stutterers who have achieved a great deal of (or "complete") fluency.
The important point here was that, even seemingly different points of
view often turn out not to be so dissimilar after all, and there are
important lessons to be learned both by other stutterers and SPLs,
whether or not we agree that the evidence for a neurological basis of
this disorder is compelling enough.

It is extremely important, in my opinion, that this list not be a forum
for matching wits, rather an honest and continuous attempt to find elements
we can use, both in terms of therapy and as well as potential causes.
I feel that you have done so several times, and obviously many others
have thought so as well, or you wouldn't have received so many thoughtful
answers. I invite you to keep up the standards of these postings and
to help us maintain the climate of earnestness and respect that has been
so typical of this community.

The effect of stress on stuttering

1995-08-04T22:48:00.000-07:00

In response to a note by Marty Jezer on the effect of stress on his stuttering.
He feels that stuttering has neurobiological origin, but that psychological factors, in the form of stress, contribute to "setting off" stuttering.

What you say makes complete sense to me. It is in fact the key to my
own "recovery". I spent years becoming aware of the subtle stress
in my body that was generally associated with "increased probability"
of stuttering. I took blocks not as "things" to be individually
examined, but as "alarm bells" of generally increased stress that
I had to bring under control. General stress awareness can be achieved
also in other endeavours such as classical singing and dance. I did
these too and they helped. I had long exchange with John Harrison
on these ideas here, a few months ago.

The point to be emphasized again is that stutterers are not any
more prone to stress than anybody else, but simply that it affects
our speech apparatus, whereas fluent speakers are not affected the same
way. Extra stress vigilance is our form of "insuline". The consolation
may be that we'll get more fluency and a "stress free" life at the same
time (we may even end up living longer... which would be a fair way to
make up for all those disfluent years!!)

Discussing the "biological appraoch"

1995-08-03T22:29:00.000-07:00

In response to Michael Sylvester's skepticism on the biological approach to stuttering "on what chromosome is the gene for stuttering located?"

Genetic links are typically established long before genetic sites can
be found. Here is a notion that keeps coming up in very strange ways.
Whether or not one supports it (and I do) it should at least be understood
clearly. There is no "gene" that will make you "stutter on the word
pumpkin..." or any specific situation (Michael, you did not say this, but
others recently have in this context). Genes are simply "blueprints" for
something that gets constructed by the body. This "something" gets
constructed once, starting with conception and through gestation and
development, or it keeps getting produced throughout life like some needed
protein. People whose genetic defect is low production of insulin, for
instance, have difficulty processing sugars and are called diabetic.
They don't have a gene "for getting sick when they eat chocolate".
We know that the speech apparatus is very complex.
Stuttering may arise from relationships between different parts not being
quite right and prone to "breakdown", somewhat like an engine that tends to
stall when the temperature is too high or too low. In this case there may
never be a "gene for stuttering". The complex interplay of genes that are
responsible for the contruction and maintenance of the apparatus would be
"responsible". It may also be that our tendency to "breakdown" is simply
due to the lack of some simple chemical. In this case a gene site could
eventually be found along with a cure based on drugs and/or genetic
engineering.

In response to Michael's note that there is lack of consistency in stuttering, as
stutterers do have periods of fluency (this would seem to contradict a biological cause)

Ever had a car that tended to break down more that others? It still
had periods in which it took you to work.

He notes that environmental and psychological factors
can have an affect on physiological systems.

Of course they do. My mother saying to me "stop it" and slapping me
for stuttering probably made it worse... until I could understand what
was happening, forgive her, forgive myself and proceed on my life-long
path to better and better speech.

Biology and "volition"

1995-08-02T23:24:00.000-07:00

To Michael Sylvester about the role of volition

"Biologic", "Neurophysiologic", "Genetic" ... what have
you... by no means implies "helpless", or that volition can play no role.
I have WANTED to stop stuttering all my life and I have WORKED at it,
as you have. By saying "eventually" it seems to me you are admitting (as
I think you have before) that "just say no" is not an easy quick fix. So are
we really disagreeing or is this just a semantic issue (as John H. suggested).
I generally like the way you name some concepts. "sustained automaticity"
is one example... and, if I understand it, it's exactly what I think
I have achieved. The only difference from your thinking (if I understand)
is that you seem to imply that the problem I worked so hard at overcoming
had been "created" by myself in the first place. I, and many others,
believe that, however you want to define it, a "weakness" was present in
my speech apparatus for me to deal with. I could have lived with it
or I could try to find some way to work around it (and I did, using
"volition" too).

Just because squinting your eyes can bring things into focus doesn't
mean you created your own sight problem! Just because squinting can
become the result of "sustained automaticity" does not mean you did
not have a sight problem. Yes, I remain hopeful that the equivalent
of unubtrusive glasses or eye surgery may at some point make all
these discussions obsolete.

Just say no?

1995-08-02T22:18:00.000-07:00

In response to Michael Sylvester's definition of "voluntary" as any "self-initiated behavior performed, which upon "post reflection," allows for the possibility that one had the choice to perform or not perform that behavior."

And by that definition you view blocking as voluntary? I would have to be
aware of the possibility of blocking (and choose not to..) at the
beginning of every sound I am about to make... I am afraid that would
put a serious damper on my communication (and pleasure in it). This
is not like choosing to eat chocolates or not..

Response to Michael's comment on some people's recognition of the therapeutic value of some of his propositions.

Nobody who has commented on your views has denied the therapeutic value they
had on you. Several, including myself, have commented positively on the value
of the block management ideas you have expressed. I also mentioned that
if a "just stop it" attitude worked for you, it may work for others, and
that's a good thing for everyone to know. As Chris Stephens cogently pointed
out, this is quite different from an endorsment of causality. If volition
were the simple cause of stuttering then chronic stuttering would be
a psychological problem. Far from a "mythical idea" this has caused
great harm to our community and has taken centuries (millenia?) to
debunk. The notion of resurrecting it "for therapeutic value" as a way
to emphasize that we do have some control over our speech, may, I state
again, have some value for others as it apparently had for you, but,
far from "user friendly", it could also cause great harm, and, in this context, I would recommend that any SLP exercise EXTREME caution in adding this to their "bag of tricks".

I also see danger in the resurrection of this notion in the media. I can
just see a 20/20 segment: "Stuttering Solved... just say no!".

To block or not to block

1995-08-01T23:03:00.000-07:00

In response to Michael Sylvester's about becoming aware of "internal states that make blocking more likely". "In the final analysis - he says -one can reach the stage where the big question is TO BLOCK OR NOT TO BLOCK!"

If you mean that one can work on creating conditions that will make his/her
blocks less likely, I agree. If you mean that when I find myself in the
clutches of a bad block somehow it's because I "decided" that this time
I'd just go ahead and block... I don't agree.

He comments that he was a "severe stutterer" because he used gross muscular movements to release himself out of blocks.

By that definition I was a severe stutterer too. I once asked a lady for
directions in Boston and I blocked so severely that she thought I was
undergoing a Dr. Jackill (sp?) to Mr Hide (sp?) transformation. She almost
fainted ... I almost did the same out of embarassment.

I suspect this is not, however, the single factor clinicians, and most
stutterers would use to judge severity. I can see how your "diary" method
would work in this case, but, as others have pointed out, when you stutter
on practically every word (or sound) it's a different story.

Let me ask something else that I may simply have missed (sorry if this
is the case). Have you had much contact with other stutterers? If I think
back, it's amazing how little contact I had until I joined the NSP. While
growing up I thought I and an older cousin were the only ones in the
world. Later I avoided other stutterers. In all I have to admit that I had
NEVER heard really severe stuttering until about 10 years ago. I am now
50 and I credit the NSP with allowing me to get over my overwhelming desire
to avoid other stutterers... and in fact opening me up to new ESPECIALLY
wonderful friendships, besides a deeper understanding of the problem.

I continue to find that your "just stop" attitude, motivator, hypothesis...
whatever...is potentially harmful both from the point of view of engendering
"etiology confusion" and most likely providing more continuing frustration than therapeutic help to many. On the other hand, if it helped you it CAN help
others, and, in this context, I am very glad you have been expressing it. I also find that your block management ideas are good. This is one of the wondrous
aspects of this field that has been shown time and time again on this list. Even
completely different and conflicting cause postulates often result in similar
and effective therapeutic ideas.

The "Scatman" CD by Scatman John Larkin

1995-07-28T22:53:00.000-07:00

(Lyrics posted be Darrel Dodge)

SCATMAN (Ski-ba-bop-ba-dop-bop)
by Scatman John Larkin

I'm the Scatman
I'm the Scatman

Everyone stutters one way or the other
So check out my message to you.
As a matter of fact don't let nothin' hold you back
If the Scatman can do it, so can you.

Everybody's saying that the Scatman stutters
But doesn't ever stutter when he sings.
But what you don't know, I'm going to tell you right now
That the stutter and the Scat is the same thing.

You know I'm the Scatman.
Where's the Scatman?
I'm the Scatman.

Why should we be pleasin' any politician's reason?
(They) would try to teach us reasons if they could.
The state of the condition insults my intuition
And it only makes me crazy, and a heart like wood.

Everyone stutters one way or the other
So check out my message to you.
As a matter of fact don't let nothin' hold you back
If the Scatman can do it, brother, so can you.

I'm the Scatman.

I hear you all asked about the meaning of Scat.
Well I'm the professor, and all I can tell you is
While you're still sleepin' the saints are still weepin.'
Those things you call dead haven't yet had a chance to be born.

I'm the Scatman.

Are stutterers responsible for their own stuttering?

1995-07-26T23:11:00.000-07:00

In response to a post by Michael Sylvester where he essentially states that the stutterer "causes himself/herself to stutter"

It's taken me a while to sort out my feelings about your statements. They
have run the gamut from anger to complete puzzlement to, interestingly, some
foundation of agreement.

First of all "your" idea is far from radical. My mother, with an elementary
school education, would say to me EXACTLY the words you used to start you
on the path to recovery: CUT THAT OUT! She would say that in Italian and
would often accompany her admonition with a hefty slap on my face.

What has been completely puzzling to me is that a Ph.D. psychologist AND
former stutterer would subscribe to the same principles. Maybe the pendulum had swung too far in the direction of "helplessness" and it's time to rethink the
role of personal responsibility. Point noted.

Again, this point is hardly controversial. Many of the discussions that have
gone on on this list have been centered on the "actions" we as stutterers
have taken to gain "control over" or "recover from" stuttering. I had a long
argument with John Harrison, for example, on the "nature" of blocking and
on the appraches that seemed to have worked for us (I consider myself
practically "recovered", and John certainly is). We certainly agreed on the
notion that there was SOMETHING we could do to get better and better at
avoiding blocks and we certainly had the WILL to start the process. We also
agreed that the process took time, and for some it might never quite "end".

These areas of agreement, it seems to me, extend to parts of what you are
expressing, but they are a far cry from implying that the process of recovery
consists of undoing - mainly by willpower - something that we somehow
"chose to do".

You seem to be making two separate independent assumptions:

1. We "choose" to start stuttering just as we would start smoking.

Could you elaborate on what "returns" this choice would provide a 3 to 10
year old?

2. Anything we chose to "do" we can "undo" with equal ease.

EVEN IF, for some misterious reason and warped reward, we actually CHOSE
to start stuttering, why would stopping be any easier than, say, quitting
smoking?

Whether or not you decide there is an "IT" to be blamed or fought out there,
the very fact that, at some point, you had to say to yourself "CUT IT OUT"
IS the problem. Fluent speakers don't have to do that. With a little bit
of attention, in Toastmasters they learn to avoid saying "Ahs" , no
traumas, intensive therapy, no relapses. Now, THAT, is just a bad habit
that can be simply willed away.

Unfortunately it is often very difficult to separate fact from perspective.
Did I will my stuttering away or did I build a good strong mechanism to
compensate for it? I do respect the fact that your perspective enabled you
to overcome your problem. Now, can you help us figure out some way to test
whether we really DO "choose" to stutter?

Do you have the same perspective on other "alleged" mental ailments? Depression
in its various forms and Tourette syndrome come to mind. Can they be willed
away as well? If not, what makes you think that neurological problems could
affect mood but not speech?

A final doubt always haunts me whenever I use my own experience to generalize
to all stuttering. I have brought it up a few times in some feeble attempts
to find out if there really is ONE stuttering problem. Granted.. highly
individualized etc., but fundamentally the same problem. Maybe "mild"
and "severe" stuttering have completely different causes, but just sound
like they only differ in severity. Doesn't pneumonia sound like a very
bad cold?

Kato Kaelin

1995-04-04T22:54:00.000-07:00

Kato Kaelin is an actor who became known as a friend of OJ Simpson during the infamous trial... As he spoke to the media, some people thought he was a stutterer. Woody Starkweather though that he was NOT a stutterer.

Woody, I must defer to you as SLP for a diagnosis, but I confess that
I am a bit surprised at how definite you sound (in spite of a very
minor qualification).

My impression is that it is also a common layman's misperception that
a highly disfluent "normal" speaker is NOT stuttering. Even blocks
are often not recognized as "stuttering" by most people, let alone
word substitution.

I came to a different conclusion (but I am far from sure) in a rather
peculiar way. I was driving home, and I started hearing on NPR what appeared
to be a very disfluent speaker trying to tell a children's story. No repetitions
or evident blocks but stuff like "hmmm ... not-a-boy ..hmm ..a.. girl..".
Far from finding it amusing I found myself getting very angry. Here we
go again, I thought, ..making blatant "fun" of a stutterer! I was already
planning to send a message to Ira asking him if he new anything about
this stupid skit when I realized this was a parody of Kato Kaelin!

Now, I haven't followed the trial much and I haven't heard more
than a few seconds of the "real" Kato. But... sure enough, the notion
that he might be a stutterer had occurred to many others on this list.
Let's not forget he is trying very hard to be an actor, and he's
probably under enormous pressure to mask any stuttering any way he
can. It wouldn't surprise me if he found that hesitating and substituting
words is a much better way to go than appearing to stutter. There are
probably not many directors that would risk giving a part to a stutterer.
His kind of disfluency on the other hand (they would probably think)
would be esasily remedied by a good script.

Why is this important enough to discuss? Because perhaps he could
use "our" help, and because, if he does turn out to be a PWS, this
could be a good chance to "educate" the public on the peculiar
forms stuttering can take. In any case, whether he is a stutterer
or not, we should react forcefully against anyone who feels the
right to make fun of him (of course having PWS come to his defense
may be the LAST thing he wants...). Is there anyone among us who
could get the story from him? (Any idea Ira?)

(Referring to Ira Zimmerman who was the self-appointed media "watchdog" of the stuttering community)

Core behaviors

1995-03-29T22:43:00.000-08:00

In answer to comments by Woody Starkweather on core behaviors

A few points:

1. I am glad you agree that this deeper or initial "core" is a key to
understanding stuttering and to early therapeutic intervention. In this
case let me be less shy about suggesting that a good name be attached
to this concept in order to distinguish it from "traditional" core
behaviors. Thinking produces language and language produces new thinking.
Labels ARE important!

2. Assuming an "initial core" a transient state and a final steady state
("traditional core" ... my modeling background is showing), then lots
of research questions come up. How long is the transient? This the
period during which we learn our own very personal way of stuttering.
Months? Years? How malleable do we remain and for how long? I have been
always struck by the notion that learning a second language before about 11
years of age (in the new country) all but guarantees the ability to have no
accent, while after that age it's always a long struggle. And my
previous questions: how does coping during this period shape the stuttering
"style"? Is an understanding of how one coped initially and during the
transient a good prognosticator for the most appropriate type of therapy?
There is much work about how one learns language. How DOES one learn
stuttering? (good hints are coming out of your work!).

3. Woody, I was very surprised when I first found out that you were NOT
a stutterer! ... And that's the HIGHEST compliment. I really think that
you and many other (non stuttering) SLPs on this list understand stuttering
>From the "inside out" in a way I didn't think was possible. I find this
very reassuring. I wish there had been such a way to communicate years
ago...

Distinguishing "core stuttering" from learned behavior

1995-03-28T00:29:00.000-08:00

In discussing stuttering therapies one needs to understand what the therapy addresses, and my point here is that much therapy addresses what can be considered "learned" behaviors.

I said

> In summary, instead of "show me how you stutter and I'll tell you what
> therapy will be best", I suggest "tell me how you have been coping with
> stuttering from the very beginning (i.e. what and HOW you are likely
> to have LEARNED) and I'll tell you what therapy will be best".

Woody S. pointed out that there is the possibility of misunderstandings in how stutterers define stuttering as opposed to how speech pathologists do. Stutterers think of repetitions and blocks as "stuttering" while pathologist often think also of the whole syndrome of maladaptive learned behaviors, such as eye blinking, word substitutions etc.

In answer to his point I wrote:

I was trying to draw a more subtle distinction, and I probably need
yet MORE help before I cause too much damage by clouding the picture
with my own brand new set of definitions.

I am addressing mainly core behaviors, and I am trying to assess how much
even these are the result of "coping". I'll try with some examples, then,
anyone, please feel free to suggest a set of clearer words, if what I
am saying makes sense.

I am a kid, and I suddenly start experiencing blocks. How do I cope with
this event? Some kids realize that they can substitute words, some feel
that they can blast their way through them come hell or high water, some
try to make it come out, give up, try again, give up and get into a long
set of repetitions. At a different level some will feel a great deal
of shame and try to avoid speaking, some will want to speak no matter
what. My point is simply that ALL of these kids will probably continue
to experience blocks but their blocking "style" will have been modified
by how they began coping with the problem.

So now you are the SLP and the kid (or now the adult) comes to you. You
see blocking, you assess its severity and start trying the techniques
you have had most success with. It seemed to me that the discussion
on screening and prognosis centered on the assessment of PRESENT
stuttering behavior. My question is the following:

Assume that two people have blocks of similar frequency and
intensity, but, at least initially, they "coped" differently with the
problem. Would they benefit from different therapeutic techniques?
Could their initial "coping style" be a prognosticator of the best therapy
for them? Are these considerations that enter the minds of SLPs when they
try to asses what to do?

Why am I asking this, and why do I think it might be important?

My hypthesis is that even much of what is viewed as "core behavior" is
in fact the result of a learning process, and that this process is guided
by your initial coping strategies. For instance, when I started blocking I
REFUSED to do anything that seemed "unnatural" to me. This included word
substitution and trying to use force to get the word out. Also, if a teacher
asked a question, ... and a little voice inside said "S. don't open your
mouth... you might be embarassed" ... my arm would go up in the air...
I trained it to that automatically! I was determined not to let stuttering
hold me back. It turns out that these were the right things to do, although
there was no therapist around to tell me that in post-war Italian public
schools. (Now I often ask myself, did I turn out to be a "mild" stutterer
because I did those things, or was I able to do those things because I was
a mild stutterer? But this is a slightly different issue)

In summary, I propose (but I am sure others have thought of this) that what
SLPs call "core behavior" is in fact the result of a learning process that
was framed by initial coping strategies. This initial pre-learning
behavior could be called.. sub-core?.. pre-core ...real core behavior? Help!
I guess we don't need a special word if this is not a useful concept, but if it
is...

Assuming then that a specific set of "coping" (different word needed?)
strategies led the PWS from pre-core to core... could these particular
strategies be better prognosticators for successful therapy than the
simple observation of core behaviors?

Whether or not what I said is useful, I hope it was clear.

Response to John Harrison regarding psychological factors in blocking

1995-03-27T00:02:00.000-08:00

In response to John's complaint that the list has been unwilling to consider his proposed explanations of stuttering blocks.

John:

I think you are being unfair. Many of us have spent a great deal of time
discussing this issue with you and, speaking for myself, learning a
lot in the process. I am not sure why this wouldn't qualify as "willing
to explore it" with you, but, whatever it means to you, have you done
so with the "opposite" view?

I have learned the following from your view:
1. Individual word "fears", conscious or subconscious, could play a role in
increasing the tension that makes our speech machinery "break down" (I already
held this view, but you have certainly strengthened it).
2. Dealing with these fears in a psychological context can help "dimistify"
blocking behavior and bring our attention to the whole of speech where it
can be of most use. I would never have thought of doing this. Now I would
consider it a good bet in helping some people.

Now, have you "learned" anything from the "genetic view"?

In response to John's bemoning of the fact that many people "latch onto" timing problems, that we can do nothing about, because they would be genetic in origin.

"Genetic" BY NO MEANS means that you cannot do anything about it! Genetics
is only the initial blueprint. It is followed by an embriologic stage AND
by several developmental and learning stages. One CAN intervene and modify
the "natural" development of any of these stages if one knows what one is
looking for! Even when one misses the developmental stages it is sometimes
possible to find chemical, surgical and yes, psychological "fixes" too.
Treatments for depression come to mind as a good example. We are also seeing
the dawn of genetic engineering. Again the key is to find exactly what we should
be looking for.

My interest in the genetic cause is simply due to the fact that I think
it will ultimately illuminate the most productive course of action in
eliminating stuttering. And NO, John, I am not afraid of appearing
psychologically "weak" by not viewing blocking behavior as essentially
psychological in origin. You can bark all you want but it's the wrong
tree. I really don't give a damn about showing chinks in my armour. I am
afraid of snakes and hights. I have had to admit to myself and others
traits in comparison to which "the psychological load" of particular
words or situations absolutely pales.

In response to John bemoning his own perception that many seem reluctant to explore other non-speech related factor that may be relevant to the problem

Do you really think that people, like many of us, who routinely get up in front
of people "confessing" to be stutterers, would have a hard time admitting
(to other PWSs and SLPs) that some words or situations are psychologically very loaded to them? Loaded enough to cause approach-avoidance behavior? Please
give "us" more credit.

I am glad that you pointed out that none of this means that stutterers are emotionally or psychologically different from fluent folks.... now I can come out and stop this silly
denial game! Come on... do you really think "genetic weakness" is easier
to "accept"? Down (sp?) Syndrome is genetic, and so is a myriad of other
mental and physical conditions people are not particularly proud of.

John, I understand how frustrating it is not to have convinced the many
of us who have discussed this issue with you. I know it is frustrating
to me that the opposite hasn't happened, in spite of the flow of much more
eloquent statements than my own. But, please, simply accept the fact that
your arguments, although eloquent, spirited, and rooted in years of great
introspection, have met their counterpart on the other side. For you
to seek solace in the notion that we are in denial or "afraid" to look at
possible psychological factors, would be the real denial. I am confident
your practice at introspection will prevent you from falling into that
trap.

Comments on list dialog and invitation to BTF

1995-03-26T22:18:00.000-08:00

In response to a message from Janet Ackerman in which I was invited to join the board of directors for the Birch Tree Foundation (BTF).

Thank you very much for your kind words on my contributions. Like many
others, I am sure, I have been tempted to give up in frustration, but
I can't let misleading statements get to the stuttering community unchallenged,
and, curiously, I came to the realization that the fact that I am not a SLP
has given me an advantage in that nobody can accuse me of touting "rival"
therapies for personal gain! You and Woody have been very careful in mantaininga low key objective approach, but I am sure it must be hard at times NOT to
intervene more forcefully and become "censors". I am very glad you have been
able to trust that the PWS and SLP populations would be better served by lettingall opinions be expressed. There would be nothing worse than turning misguided
people into underground heroes.

The silver lining is, I hope, that even long, circular and unresolved
discussions are revealing how the "players" think and are educating people
on facts and methodologies. People who start off with radical positions will
rarely change their view, but I think there is a "silent majority" out there
who has been learning a few useful things.

A suggestion I have is, perhaps, to be a bit more proactive in getting issues
to the fore, so that new interesting issues get to be discussed instead of
being compelled to react to the old ones again and again. Sometimes the best
way to eradicate weeds is to plant a lot of "good stuff" around!

Now, to your offer. I am truly deeply honored that you would invite me to
work with people such as yourselves and the present members of the board!
With the caveat that, at this point, coming by travel money would be a
hardship for me, I would be thrilled to contribute to your endeavor. It
would eventually kill my "neutrality" but what the heck..

Fortunately a lot can be done nowadays with email, faxes etc. and I am
well equipped for long distance collaboration both in my office and at
home, so, let me know what you have in mind!

Control and stuttering variability

1995-03-22T23:33:00.000-08:00

In response to the point that there is great variability in stuttering behavior

It's hard not to agree with that statement, but what does it REALLY tell
us? Not much unfortunately. Most of all it does NOT tell us that there
are different CAUSES for each individual, but only that there are
different ways of coping, and this is really not surprising. If you
catch a cold your body's immune system reacts, you sneeze, maybe have
a fever. None of these things are under conscious control so all human
bodies tent to react in similar ways.

Speech, on the other hand, is, at least in part, under conscious control
and is learned. It is not surprising then, creative as we are, we'll find
extremely individual ways to cope. If we had conscious control over the
symptoms of cold (or even if we thought we did..) and found that by
hopping on one leg or flapping one arm you could prevent some of its
symptoms, you'd find a lot of people adopting the strangest behaviors
during flu season and you'd say that colds too are as individual as people!

While this variability certainly calls for (and explains the relative
success of) individualized forms of therapy, it is important to try and find
the commonality of what is happening. Even the "argument" between John
and myself, I think, ended in what I perceive as a deep agreement in
how we both have dealt with blocks (i.e. dimistify the individual block
and look at the whole "speaking picture").

Even control vs. non-control is, in my opinion, a non-issue. This is
in part because we don't agree on what we mean by "control". Some people
think of "easy stuttering" as non-control. I think any injection of
consciousness in the mechanics of speech is "control". Again, it is
not surprising to me, given different mind sets and different learned
behaviors, that different stutterers may feel helped by fluency shaping
while others prefer easy stuttering. Still, the common goal is to produce
acceptably fluent speech WITHOUT having to think of the mechanics of it, and
many of us have learned that, in time, this can happen more and more.

I find it interesting that the closer stutterers get to fluency, the
more similar their stuttering "style" gets. Is this so "by definition"
since they are close to fluency?... I don't think so. I think that, as we
throw away much of the learned useless baggage, stuttering becomes quite
uniform. Do any SLPs agree with me on this point?

Objections to "Stuttering University"

1995-03-17T23:16:00.000-08:00

In response to the problem of a "separatist enviroment" (problems "re-joining" the fluent world)

I share this concern, and considering that it took me years before
I could comfortably approach other stutteres, I surprised myself in
having changed my thinking. (What follows is part of previous private
posting) The university idea stems from solving the constant dilemma between approaching stuttering by focusing on it and by NOT focusing on it. One could get a degree without attending a single therapy session and yet have "worked" on
one's stuttering by approaching every subject in the context of his/her
path towards whatever degree of fluency s/he sees as a goal. All in
a supportive environment.

Women have used the "supportive environment" argument to justify women's
colleges. I don't know what it is about us stutterers... but even admitting
the need for a supportive environment seems hard to do. Perhaps because
of the 4 to 1 ratio of male to female stutteres there is a pervasive
"malist" attitude that we should be "tough enough" to take on whatever
comes our way. Dare I say that we need larger dosage of good nourishing
"female" thinking?

Response to the "relapse problem" following successful intensive therapy

The idea is precisely to prevent this problem. An "intensive therapy
environment" could not be sustained for 4 or more years. It would have to
become REAL life along the way... good grades, bad grades, your girlfriend
dumps you.. your roommate snores. A recent posting on how John H. and
I agree on this issue should clarify why I think this would work differently,
but I could be wrong, of course.

The more I think about it, though, the more I am becoming convinced that four
or more years where we can FORGET and NOT FORGET about stuttering and
LIVE, with it, without it, though it ... whatever .. could change the
lives of many people.

Response to the need for a better name... ("it's the people who stutter, not the university!")

Before it becomes real, if ever, I am sure we'll figure out a better name,
all the more so since (imagination being so cheap anyhow) I actually envision
some non-stutterers wanting to enroll. Why? The best SLP department, great
engineering, computer science and biology (for control, artificial
intelligence, brain modeling etc.), great liberal arts for personal
growth, international atmosphere, and yes, lots of PWSs... the best
bunch of folks that ever walked the earth (please allow me one of the
few elements of pride allowed to stutterers... you have to become a pretty
special person to survive stuttering with some degree of sanity.. and
most of us do! :-)).

To John Harrison: some points of agreement

1995-03-17T23:10:00.000-08:00

Just when I thought that we had parted company and were merrily walking
in different directions I find you again! I agree so much with what you
said in your posting that I had a very hard time selecting just a sentence or
two for reference.

First of all, even though we don't agree on the "nature" of blocks, we
essentially did the same thing: we DIMISTIFIED THEM. You did so by
analyzing what you thought might be underlying psychological causes. I
did so by simply ignoring them, acting as if they hadn't happened and
moving on. Let me add an analogy to all your great ones.

Let's face it, we are lousy windsurfers in the "sea of speech". Fluent
folks seem to be able to navigate no matter how rough the sea gets. As
soon as a few waves show up down we go..

Now, if we really concentrate (focus on "targets" etc.) we can survive
a good wave, but, sure enough, here comes another one... and another
one. It's a lousy way to surf... no fun at all.. and pretty soon down
we go anyhow. Fortunately it turns out that in the "sea of speech"
we can do one very interesting thing: with some effort we can actually
LOWER the waves ("tension"?)! Great! So here comes a wave.. Quick.. remember
your techniques... concentrate.. LOWER the wave! Smack... you hit the
wave... sorry it's too late to do anything about it now... and down you
go. Why can't we lower every damn wave when it comes? Because if we
wait until each particular wave comes it's always TOO LATE.

What's the solution? Forget about each particular wave, look at the
whole sea, look at the sun, enjoy the wind pushing you through the
water. You CAN make the whole seascape calmer, and if you still fall once
in a while it's OK.

I found that when I switched from monitoring each single wave (word) to
monitoring the whole sea the going got a lot easier. Each block was
not an enemy to be conquered so I could go on to the next one (talk
about fatigue!), rather it was a signal, a reminder that a battle had
ensued that I wanted no part of. So I'd back off, wait for the seas/battle
to calm down, and I'd get going again. Eventually I found that I needed
fewer and fewer blocks/signals to remind me to calm the sea, and I found
that the blocks became less severe and often barely perceptible. I also
found that even the tiniest blocks, unnoticed by anyone but me, were still
very good "signals", so I didn't have to wait until major blocks to
remember to lower the waves... I could just keep them down constantly and
ENJOY my speech-surfing excursion.

What are the consequences of this view for therapy? You have just gone
through a two week workshop and you are doing pretty well. Now if you
could just keep doing the same "things" in the real world... right?

WRONG!!!!

You are not at the end of your therapy, YOU ARE AT THE BEGINNING! You have
learned to survive that big wave when it hits you, and that's a great
skill to have, but that's not speech. You have speech, enjoyable speech
(as it should be by definition) when you have learned to create the
conditions that make the sea calmer and calmer and when, in fact, the
techniques you have learned become easier.. and ultimately unnecessary.
It's no wonder to me that so often people simply tire out and "revert" to
the old ways. Techniques are not "solutions" to be harked back to. They
are temporary band-aids to get you on your way. My believe is that future
therapy will, in fact, include the much harder process of "removal" of these
band-aids... I have tried to illustrate here how I have tried to do just
that for myself.

John: I forgot I was "talking" to you... and got on my soap-box. From what
I have read in your postings, it seems to me that you removed your "band-aids"
in much the same way, and I think this is important feedback to both SLPs and
fellow stutterers.

Clarification on my stuttering competence

1995-03-15T23:03:00.001-08:00

I have been sent private e-mail asking my opinion on various issues and
how they might differ from John Harrison's. With John, I have been very active
on the list lately, and I am very grateful for the opportunity to do so, but
I want to make sure there is no misunderstanding on my level of "authority"
just because my opinions appear frequently...

I am NOT a SLP. I am a scientist, trained in Physics (MA), Biophysics (Ph.D)
and Computer Science. I have been working at NASA for the past 15 years and
I am now doing research in the area of Neuroengineering. I am also a stutterer,
although on a good day you might never guess it. I have had only brief
encounters with therapy and I consider myself mostly "self-taught" in how I
deal with my stutter.

Now to John, me and dealing with blocks. John and I are friends and see
each other occasionally at NSP functions. I have NEVER heard him block or
repeat in any way that would make me think that he had ever stuttered, so
he MUST have done something right. I think my stutter is more easily
revealed but I am also quite satisfied with my own progress. The reason
I am posting this is that many might find it interesting to note that both of us seem to have overcome blocks by coming from different directions. This
certainly accounts, at least in part, for our "philosophical" differences in
this area.

John (I am sure he'll jump in if I misrepresent him) seems to have "studied"
each block as it happened, wondered what was about that particular word
that might have made him want to avoid it, etc. This increased level of
awareness slowly seemed to "melt away" the blocks (correct John?).

I, on the contrary, approached blocking by completely ignoring and quickly
forgetting any word I might block on. I felt (and still do) that blocking,
in its basic essence, was an "accident" that could happen on any word, for
no particular reason, and that, in fact, if I lingered on the word,
wondered why etc., I might add an element of fear to that word, which would
make it more likely that I would block on it again (yes, I recognized a
"psychological" component). I directed my awareness instead to my speech
apparatus as a whole, to decrease any tension in my body and promote
a general sense of well being and joy of speaking no matter what. What I
mean is that I would NOT think something like "oh my God, I've got to
speak... I'd better RELAAAAAX", rather, I would try to make my body
awareness INDEPENDENT of any speaking situation, something I could
cultivate through dance training (I took Ballet, Modern and Jazz training
for 7 years) and classical singing (I know we don't stutter when we sing,
but that wasn't the point). All of these disciplines deal with eliminating
even very subtle tension from your body to free it for the production
of beautiful movement or sound, and to make the whole process as automatic
and subconscious as possible so your mind and body are free to create "art".

I think I slowly learned to tap into that same state "on demand" and use it
to support my speech (and, when needed, the various techniques and "tricks" you learn in therapy). I am not suggesting that everyone should spend ten
years learning dance and classical singing (although it WAS GREAT FUN, and I
met my wife, a beautiful dancer, along the way), but simply that this path is
SLOW, so we might as well try to make it fun, in whatever way suits us best.
Having seen how difficult it is to achieve the subtle control it takes to
become a good dancer or a good singer I have a hard time even conceiving
how anyone can expect that even a few weeks of therapy will "cure" stuttering.
Yes, you can learn tools and tricks that can come quite handy, and can
get you started on your way. But from that point to feeling a true joy
in speaking is a long way... but I really don't mean to sound discouraging,
it can be a FUN way too.

One last thing (apologies for the length of this). I should just mention
that this is precisely the context in which I proposed a "Stuttering
University": a place where stuttering can be "forgotten" and worked on
at the same time... all while having fun... learning... and living.

On "blocking"

1995-03-08T22:47:00.000-08:00

Continuing a dialog with John Harrison in response that his feeling that blocking is a "strategic response"

Yes, we part company. It feels to me like a bunch of sand has been thrown,
so to speak, onto my speech apparatus. And that causes me to stumble, not
everywhere "at random" but at linguistically significant points, such as
word beginnings. I think not because these words are somehow "loaded" but
simply because they are there. It's as if speaking is like crossing a stream
by hopping on stones. If your legs get weak you end up slipping and stumbling
on some of them.

John feels that there is always an "approach avoidance" conflict present in blocks. He asks "how do I know it's not present"?

That's right, I don't know, and neither do you. I think it's great that,
having both had the dubious "advantage" of feeling stuttering from the
inside, we have concocted different "models". This should give some
reassurance to our friends SLPs who don't stutter!

We agree on so many things that I had lost sight of (or never understood) what
we did not agree on. It really would be boring and perhaps hopeless if we
all marched in lock step. The important thing is we have identified two
possible "models" (if mine can be thus dignified). You attach important
psychological udertones to blocking, I, while not denying that
these could play a role, see "generic" tension as a more direct cause.
Your mental image is "approach avoidance" conscious or unconscious, mine
is "sand in the machinery". I think these different views can have therapeutic
consequences. The next step is to see whether there is any
evidence out there to support one or the other. Do any SLPs and or researchers
on the list have an opinion and/or can cite evidence to shed some light?
(As usual... sorry if all this is old hat..)

Response to a "defender" of Dr. Schwartz's therapy methods

1995-03-08T22:37:00.000-08:00

I am really happy that you and many others
have achieved the best results you could have hoped for. This is a credit
to both Dr. Schwartz and to your determination. I can (believe me) feel
the pain you must have gone through in so many false starts and false
hopes, and I understand your desire to share your success with everyone.

Unfortunately a scientific forum like this one must seem quite stubborn
and cold-hearted at time. The very simple fact is that Dr. Schwartz's therapy
has been an equally painful false start for SOME stutterers. I know,
if they had REALLY done it... but this is precisely one of the very
legitimate issues we have been trying to pursue. There is NO SLP I know
who has not had what they would regard as "failures".

So where does that leave us? Many people have come on the list stating
that they had received benefit from Dr. Schwartz's therapy. Nobody had
any negative reactions to their saying so. I personally reacted to your
postings simply because you came across, at least to me, as saying "here
is someone who has THE answer and nobody is paying attention for some
unspecified warped reasons". Well, even aside from my own differences
in thinking, most postings I have seen on this list have found fault
with some aspect of Dr. Schwartz's model, or of his definition of "success".
This is a simple fact I felt obliged to state. Why? Simply because I
think stutterers should be able to make informed decisions.

It is also a fact that many, including me, have paid attention, asked
questions, agreed or not agreed with answers, and conducted what I feel
has been a fair, albeit often inconclusive, debate (I am still ready
to send you what I have collected, if you are interested).

Can I ask you to please help us continue in this fashion? Dr. Schwartz
has been perfectly capable to conduct the debate about his model and
his therapy. Your testimony has been noted. Could you tell us what
hadn't worked in past therapies? What your specific objections are to
other models? I am sure you could come up with more.

There is no conspiracy here. We are all in the same boat. Many of us
have been through a great deal of pain, and all of us are trying to
spare it from others both close to us and far. Let's help each other
do so.

Dialog with John Harrrison

1995-03-07T22:28:00.000-08:00

Thank you for taking the time to point out and address in detail many
crucial statements made by Dr. Schwartz in his book. This has been a
great service to us all whether or not they will be "dismissed" by the
author. I agree with you in the general thrust of your arguments, and they
bring to mind a couple of points I would like to make.

It is clear to me that progress in stuttering recovery is greatly enhanced
by (or even requires) bringing together the best of our mental capabilities or,
as you aptly put it "getting our s**t together", but this is NOT because
stutterers are inherently less together than the rest of the population
(one just needs to attend a few NSP meetings to convince oneself of this
fact), but simply because the beast is hard to tame and we must gather
all the strength we can get, wherever it is. For most people speech is
a nice stroll in the woods, for us it is mountain climb. Strollers can
get by with average fitness, we need to be athletes, mental athletes.
I pointed this out in the context of another post, but it's worth repeating.

The other point, where perhaps we don't agree, but it's worth a discussion,
is your concept of blocking, essentially Sheehan's approach avoidance. My
past experience of blocking might fit, in the sense that I remember fearing
certain words and sure enough... I would block. But relatively soon, I realized
that fear or no fear, if I monitored my general level of tension and eased
into the words, they would come out fine. In time this of course decreased the
fear and made the whole thing easier, essentially reversing the cycle. But
here comes the clincher, occasionally I still block, but is seems to be right
out of the blue, no fear of words or situations, it's just like russian
roulette. What is still true is that, if I monitor (and lower) the degree
of tension of my whole speech apparatus these "surprises" occur very rarely.

So here is what I think. For reasons yet unknown our speech apparatus
(yes the WHOLE system as you would say) is particulalrly vulnerable to
tension and there are several areas in which it can "break down". One of these
is the articulation at the beginning of words (here is where the
SYSTEM comes in, including the cognitive levels where the idea of "word"
is formed, as opposed to low level causes such as "spasms"). Yet, while
approach avoidance increases tension, it is GENERIC tension that cause
(by yet unknown mechanisms) blocks, NOT the specific tension surrounding
avoidance of a particular word. This still implies that approach
avoidance behavior is very likely to be associated with blocks, but it
allows for a situation, like mine, where the absence of this behavior still
does not guarantee the complete absence of blocks.

In summary, approach-avoidance -> tension -> blocks. When approach-avoidance
is the overwhelmimg source of tension then it looks like a direct path
approach-avoidance -> blocks. BUT, even when there is no approach avoidance,
you can still have tension (from other sources) -> blocks.

Does this make any sense to you or others? Are there therapeutic
consequences to this view?

While I am on the subject of blocks, I have always felt uncomfortable with
notions of "airflow blockage" as implied by the Valsalva maneuver analogy.
I have certainly seen people exert a lot of effort to get a word out, including
face contortions that might remind one of suffocation (I learned to "give up"
at the first hint of effort), but It seems to me
that many blocks are actually accompanied by a lot of sound and flowing
air. The cords are vibrating, air is coming out, what is blocked, it seems
to me, is the ARTICULATORY process, i.e the MENTAL process of moving on to
the next sound. It is as if a pianist tried to play a melody and only managed
to play the first note, the pianist then tries again, and, again, only the first
note comes out. They keys are fine, it's the hand that can't continue. It's
this mental "hand" that gets stuck, the next nerve impulse that's supposed
to come down the pipe, but won't. Can others confirm this observation
or am I dreaming? I hear blocking on vowels and sounded consonants I can
recognize... so air and sound are coming out! Why can't we go on to the NEXT
sound? That, to me, is the key.

An institute?

1995-02-27T22:10:00.000-08:00

In response to a comment about an institute

Well, for one thing an institute can be a stepping stone towards a
University, and perhaps the only realistic approach. BTF (and I
have been reading about it only very quickly) might well be an
excellent example.

Fortunately imagination is cheap though... The university idea stems
>From solving the constant dilemma between approaching stuttering
by focusing on it and by NOT focusing on it. One could get a degree
without attending a single therapy session and yet have "worked" on
one's stuttering by approaching every subject in the context of his/her
path towards whatever degree of fluency s/he sees as a goal. All in
a supportive environment.

Women have used the "supportive environment" argument to justify women's
colleges. I don't know what it is about us stutterers... but even admitting
the need for a supportive environment seems hard to do. Perhaps because
of the 4 to 1 ratio of male to female stutteres there is a pervasive
"malist" attitude that we should be "tough enough" to take on whatever
comes our way. Dare I say that we need larger dosage of good nourishing
"female" thinking?

The more I think about it, the more I am becoming convinced that four
or more years where we can FORGET and NOT FORGET about stuttering and
LIVE, with it, without it, though it ... whatever .. could change the
lives of many people.

Stuttering University

1995-02-23T21:54:00.000-08:00

These broadened therapy concepts remind me of an idea I have toyed with
on and off for some time: a Stuttering University! The model might be
something like the university for the deaf (sorry, the name escapes me
for the moment) but the idea would be more than creating a "safe"
environment for learning. The idea is a place where, in the context of
getting a degree, a student can approach stuttering from all possible
angles.

It would also be a place where research, both therapeutic and basic, could
thrive.

Some examples: I feel that one of the best things I have done for my
stuttering has been to study dance for several years! I wasn't sure it would
help, but I had a gut feeling that increasing the general awareness of my
body and areas of tension would help me achieve a "natural" kind of
control.Take it for what it's worth, but I think it really helped. Anyhow,
thisis only an example of how learning (and having fun!) in different areas,
including art, drama (I've done that too... equally useful!) can be brought
tobear to tame this beast.

In the context of research, this could be a major center for brain studies,
brain disfunction, artificial neural networks (my area!), psychology...
the sky is the limit! We could also have a media center to produce
materials for schools and networks. There could be a school of engineering
focused on control theory, systems, artificial speech, electronic aid
devices, computer science.

SU (Stuttering University.... I know, we can come up with a better name)
would be international... and I would love to see it located in the
S. Francisco bay area (where I live... of course). It would also have
a strong Internet-based component, to allow some level of attendan(virtual
attendance) for people who couldn't manage to move here for the required
time.

How about it? Could we do it?

Model-1

1995-01-25T21:43:00.000-08:00

To M. Schwartz

> We have gone around in one big loop. In an earlier message you
> described three apparently seperate "theories" of stuttering (organic
> based, tension based and learning based), then made the following statement:
>
> > > "So, as you can see, all three theories are correct and all have their
> > > appropriate place in the model"
> > >
>
> To this I replied the following
> >
> >
> > Indeed I think all three "theories" are "correct" i.e. they cover
> > likely important aspects of the stuttering phenomenon, but I fail
> > to see how your model is a particularly parsimonious way to account
> > for them.
> >
> > An organic weakness can easily make someone more vulnerable to
> > tension (some people blush instead of stuttering - my palms sweat...AND
> > I (used to) stutter under tension). In addition, when faced with
> > difficulties, we learn behaviors that seem to help us overcome them.
> > Sometimes these behaviors end up being worse than the problem. Persons
> > who blush may cover their faces with their hands, which may end up
> > being more noticeable than the blushing...
> >
> > In this context one can have therapies that work at decreasing tension,
> > unlearning unproductive behaviors and/or learning good ones, and, if
> > a good drug is found, the "root" organic problem might be addressed
> > as well (too much or too little seratonen...or what have you).
> >
>
> This simple explanation of how these ideas can easily be combined in
> providing a rough accounting of stuttering behavior is what I called
> "model 1" ... just as a reference point. I make no claims of having
> created or proposed a model that is "mine". Model-1, it seems to
> me, (please SLPs correct me if I am wrong) underlies most therapeutic
> efforts in stuttering.
>
> My question to you was and is very simple: are there stuttering behaviours
> which can be accounted for ONLY by your model and not by this
> reference model (Model-1)? I really would like to understand.
>

Stuttering "cures"

1995-01-23T23:19:00.000-08:00

This is a response to a post where M. Schwartz compares his stuttering therapy to an "antibiotic" that could cure everyone... as long as they agree to take it...

The "bacterial infection cure" analogy is a perfect example of the
kind of complete misunderstanding of the stuttering phenomenon that
has plagued relationships between PWS and SLP. I am sorry for
letting go of my customary scientific circumspection. This is a
stutterer speaking now, and one who is very grateful for the kind of
care and real understanding that is being dispalyed by most SLPs on this
list.

You put me in a room, ask me to focus on fluency for a reasonable
period of time and you won't be able to tell me apart from any
other fluent speaker. I have learned to control my speech so that
I don't stutter if I put my mind to it. Am I cured? Can I then set
forth and "Stutter no more"? In analogy with the Cristian Scientist,
am I making a CHOICE not to use the speech "tools" I acquired because
I believe that God willed it that I be a stutterer? Do I have some
perverse psychological reason for refusing to use the tools that
would liberate my speech for good?

The answer is NO to all of the above. The simple fact is that
the controls that enable me not to stutter require a constant mental
effort that fluent speakers do not have to exert. The problem
is not that I am unable to exert control or that I am unsuccessful
at it, the problem is that I HAVE to. THAT is the problem. Therapy
that focuses on providing these control techniques is certainly
welcome for those who need it, and many do, in order to do the
many things we have to do to survive, but please don't call it
a cure! The problem is still there even if we can momentarily
get around it.

People leave therapy programs because they either have difficulty
accomplishing these speech "control" tasks, or because they
realize this is not what they thought a "cure" would be. In some cases
they even feel that exerting speech controls is far more cumbersome
than stuttering.

This is the reality of the stuttering phenomenon, and this aspect needs
to be accounted for by any "model" of stuttering just as much as
all other obvious external manifestations.

It is also the case that speech controls can become less cumbersome
and more "subconscious" with time (my experience). Perhaps new
neural "remedial" pathways are formed, just like learning a new
language. This "model" however does not account for "sudden cures".
So, there are four possibilities: they are not really "sudden",
they are not really "cures", the phenomenon was not really
"stuttering" or the model is wrong.

The law of parsimony

1995-01-23T21:32:00.000-08:00

> Dr. Schwartz:
>
> This is getting a bit tangled, but let me try anyhow.
>
> You started by presenting three "separate" theories of stuttering and
> went on to state that your model nicely accounts for all of them (the
> ONLY model that does so, you further added in your reply).
>
> I stated that the three "theories" seem quite compatible to me and that
> they already formed what could be viewed as a reasonable "model"(let's
> call it Model-1 for future reference) . I asked therefore what your
> model added to this "simpler" (i.e. more parsimonious) model.
>
> You stated in your response that your model is "extremely parsimonious",
> further more, if there is any complexity I don't understand you'd be
> happy to explain it to me.
>
> OK. now I can clarify my point:
>
> "Parsimony" means to explain all the facts with the least amount
> of assumptions. You make some clear assumptions about the role
> of vocal cords (thank you for your misspelling correction - caught me
> red faced on that one). What additional explanation do these
> assumptions provide, which Model-1 could not explain as well?
>
> There are two good reasons for adding complexity to models: explaining
> more facts and providing for the possibility of testing (which still
> is a form of "more facts"). I still don't see which facts your model
> explains which are nor explained by model-1. With regard to testing,
> I praised your model, in that it opens up the possibility of discussing,
> indeed testing, the role of vocal cords in stuttering. But here again,
> you seem very quick in dismissing evidence that might challenge your
> assumptions. You claim that repetitions in sign language do not obey
> "rules" of stuttering and considering them is "misleading and confusing".
> What rules are you referring to? It would in fact be very interesting
> to see how different this type of stuttering is and whether any
> differences are a rather obvious result of the differences in communication
> channels or hide something deeper. Also, could you provide a couple
> of examples of how, in your thinking, the laryngectomy papers you have
> had the time to survey tend to support your model?
>
> By the way, I do not equate "complex" with "unclear". As a Ph.D. in
> Biophysics and NASA researcher for 15 years in areas from
> closed ecologial life support to artificial neural networks, complex
> models and scientific methodology are my daily bread.
>
> Let's keep trying.

Three aspects of stuttering

1995-01-12T22:39:00.000-08:00

To Martin Schwartz (about three aspects of his model)

> Indeed I think all three "theories" are "correct" i.e. they cover
> likely important aspects of the stuttering phenomenon, but I fail
> to see how your model is a particularly parsimonious way to account
> for them.

Schwartz answers that only his model integrates all three aspectw in a comprehensive way. As such he believes it is parsimonious.

>
> An organic weakness can easily make someone more vulnerable to
> tension (some people blush instead of stuttering - my palms sweat...AND
> I (used to) stutter under tension). In addition, when faced with
> difficulties, we learn behaviors that seem to help us overcome them.
> Sometimes these behaviors end up being worse than the problem. Persons
> who blush may cover their faces with their hands, which may end up
> being more noticeable than the blushing...

Schwartz agrees that there is an organic weakness

>
> In this context one can have therapies that work at decreasing tension,
> unlearning uproductive behaviors and/or learning good ones, and, if
> a good drug is found, the "root" organic problem might be addressed
> as well (too much or too little seratonen...or what have you).
>

Schwartz agrees

> What additional explanation justifies the extra complexity of your
> model? I do see one advantage in the detailed cause-effects you
> have spelled out - as I understand them - and that is that there
> are instances where the model can be seen to fail. The model I
> very simply expressed is NOT very useful in the sense that it is hard
> to figure out a test case where it would fail. Again, a good model
> is one for which one can at least think of a situation where, if the
> situation applies, the model fails. If a particular model can never
> fail it's not particularly useful, and this includes the one I
> expressed.

Schwartz denies that his model is "complex" and doesn't understand my second point
(if there is no situation for which the model can fail, then it's not a good model - This is a fundamental concept in science)
>
> Now, your model IS useful in postulating the dominant causative role
> of vocal chords, because now we can test it! If the vocal chords are
> not involved stuttering shouldn't happen. Evidence has been cited, such
> as stuttering behavior in sign language... and you have dismissed it
> as irrelevant to the problem. I am still scratching my head trying to
> figure out how you can possibly consider it irrelevant. How could
> it be more central? Also, have you had a chance to look at the other
> evidence involving vocal chords (I don't recall whether it dealt
> with surgery or paralysis, but it was cited by Woody and you said
> you wanted to find out more about the extent etc.)?

Schwartz doesn't consider stuttering in sign language "stuttering", so point is irrelevant to him. He also claims that the laryngectomy literature supports his model.

>
> While I am stirring the pot, let me bring up one situation that
> is not explained even by the weak model I presented. You mentioned it
> in a response to the list: that of "sudden" and "complete" cures.
> I encountered one person who claimed to have awakened one day with
> not a trace of his previous stuttering. I also know of people who
> claim to have had out-of-body experiences. Are we here in the realm
> of parapsychology or have serious studies been done of such cases?
>
> I can see how "complete" cure can be a matter of perception. I could
> start saying that about myself and probably nobody would argue, but
> "sudden"? As if someone could shake a loose wire in the brain and
> re-establish a missing contact? Any ideas?
>
Schwartz says that he will relate his experience on people who "stopped" stuttering later on.

Trying to understand what Martin Schwartz is saying

1994-12-07T22:31:00.000-08:00

To Martin Schwartz

> I stated:
>
> It seems to me that what you are saying is: that's where sounds are produced,
> and certain conditions in terms of tension must be present for this production
> to be enabled. If the right conditions are not present then the sound
> will not come out or will repeat or whatever...i.e. stuttering.
>
> IS THIS A FAIR, ALBEIT OVERSIMPLIFIED, CHARACTERIZATION OF YOUR
> FUNDAMENTAL ARGUMENT?

Is stuttering a "vocal cord" problem?

1994-12-06T15:52:00.000-08:00

Post directed to Martin Schwartz

Frankly, I must still be missing something. I have been waiting for "the
other shoe to drop" in terms of compelling evidence about cause and effect
(the vocal folds being the cause), but, in spite of your well thought out
separation of different types of tension at the folds and how different
combinations could be associated with different types of stuttering, I still
fail to see why that should be the CAUSE.

It seems to me that what you are saying is: that's where sounds are produced,
and certain conditions in terms of tension must be present for this production
to be enabled. If the right conditions are not present then the sound
will not come out or will repeat or whatever...i.e. stuttering.

I am biased against this view in a number of ways. The vocal chords are
the site for sound production but not for SPEECH production... The
brain is where the control commands for speech originate and that's where
I think they get screwed up, probably by the very same set of tensions you
think impair the vocal folds. My bias comes from a background in control theory
and my background as a stutterer.

>From a law of parsimony point of view it seems to me that the very sensitive
coordination of control commands required to set speech in motion is a much
more likely site of vulnerability than the much more ancient and sturdy vocal
chords. From a stutterer's point of view I must also say that I simply do
NOT feel blocked at the throat, I never have, and at this point in my life,
I have very little tension in any part of my speech apparatus. Now, I realize
how unreliable subjective "feelings" are , which is why I called this
a "bias" as opposed to "evidence".

Speaking of evidence, what do you think of the evidence cited by Woody,
which implies a speech disorder as opposed to a "sound apparatus" disorder?
This, of course, reinforces my original bias, but I hadn't been aware
of it. In particular I am intreagued by the problems in sign language.

Of course my lack of agreement in no way implies lack of appreciation
in your efforts at unraveling this nasty problem and at pushing some
sense into thick heads like mine.

The need for sensory feedback

1994-11-07T21:41:00.000-08:00

What follows is the first of several posts centered on a model of stuttering proposed by Martin F. Schwartz, according to which the root cause of stuttering is at the level of the vocal folds.

This was written in reaction to one of Schwartz's ideas on selectively destroying sensory laryngeal nerves...

> This seems to me like a very strong assumption about what "triggers stuttering".
> Isn't sensory feedback needed to be able to talk at all? I guess in principle
> one could go "open loop" (in the control jargon) after having learned... but
> how long would that last? Is there any illness that simulates that and
> which we might look at?

An answer by Bob Volin mentioned how speaking adults who have profound hearing loss eventually see a degradation in their speech. This and other similar phenomena confirmed my idea that feedback is not a mechanism to be easily dismissed. Eliminating feedback for therapeutic purposes was extremely suspect to me.

Frequency distribution of stuttering severity

1994-11-04T16:38:00.000-08:00

I asked about the statistics of stuttering severity. The answer by Woody Starkweather (Temple University) is that, as for "neary all" disorder severities the distribution is right-skewed with many mild stutteres and few severe ones.

A single number index of stuttering severity has been developed. It's called PDST (Percent Disfluent Speech Time) and it includes "possibly most" elements of stuttering severity. It is computed by dividing the sum of the times of stuttering behavior durations by the total duration of speech time.

Some initial questions

1994-10-31T14:49:00.000-08:00

>I understand there are different types of stuttering, and I am not sure about
>the exact terminologies, but one might, for instance, start stuttering after a
>head injury (adult onset?). Let's just talk about "mild" vs "severe"
>stuttering.

Answers:
1. Acquired stuttering (sudden onset in adulthood) is rare and typically due to some brain injury.
2. The usual "developmental stuttering" is a childhood disorder that usually manifests itself between 2 and 9 years of age.

>Do these (mild and severe stuttering) have essentially the same etiology, with >severity being caused by additional layers of learned "bad habits" ? Or is there >something fundamentally different?

Answers:
1.Basically we do not yet know the etiology of stuttering.
2.However mild and severe stuttering appear to differ considerably in how they can be treated and how they respond to treatment.

>As a mild stutterer I have had the tendency to assume that the techniques I
>have used successfully to control my stutter are equally applicable to severe
>stuttering. Is this a good assumption? Is there value in questioning it?

Answer:
Effectiveness of techniques depends more on actual speech behaviors than on stuttering severity