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I have been deeply involved in sharing my understanding with fellow stutterers, speech and language pathologists and researchers, especially in the 90's. The older part of this blog reports some the discussions I was having on a professional list at that time. Most of the discussions are still relevant today.

I remained involved in the stuttering community, mostly as participant in activities of the National Stuttering Association (NSA), and occasional workshop leader. Since my retirement I have returned to writing, and I just developed an audio course on fluency improvement and I wrote a related book . Links for the course and the book can be found in this blog in the right column, as well as posts based on more recent discussions I am having in a Stuttering Facebook group.

Tuesday, March 07, 1995

Dialog with John Harrrison

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.

Monday, February 27, 1995

An institute?

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.

Thursday, February 23, 1995

Stuttering University

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?

Wednesday, January 25, 1995

Model-1

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.
>

Monday, January 23, 1995

Stuttering "cures"

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

> 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.

Thursday, January 12, 1995

Three aspects of stuttering

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.