Fluency: When is enough enough?

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

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)

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?

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?

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

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

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!).