Blocked: The Frustrating Mystery of Stuttering
A book proposal by Mark Pendergrast
The social studies teacher pursed her lips. “Class, we have a tie between Barry and Joe for who will represent our school at Boys State,” she said, referring to the annual mock legislature for selected high school juniors from across Connecticut in 1958. “So you have to choose. Just remember as you vote that we want someone who will represent us well, who will speak freely and articulately.” Barry Guitar sank lower in his desk. He knew now that he had no chance because of his stutter.
Humans are the only animals who speak to one another. Whales, wolves, chimpanzees, birds, ants, and other creatures can apparently communicate in their own ways, but none approach the complexity of human speech. Not even the opposable thumb or the ability to recognize oneself in a mirror are unique to Homo sapiens. But speech is. Our brains evolved to allow this unusual capacity. Most infants begin talking in single words by the time they are one year old, and by the time they are three, they are prattling away.
The art of speaking requires the coordination of some 100 muscles of the face, neck, and chest in exquisitely timed flow, in conjunction with feedback from the ears. Almost miraculously, for most of us, after some baby-talk, lisps, and stumbles as we learn, the art of conversing becomes automatic.
It is hardly surprising, when you consider the complexity of this skill, that smooth speech does not come automatically for some people. They stutter, or as the British put it, stammer, with varying degrees of severity. Sometimes they repeat an initial consonant or vowel; sometimes they prolong a sound, unable to break through to the next, sometimes their vocal chords lock in place like a vise in a total block, as their face contorts with the effort to spit out the word. Although they understand language perfectly well and can write without difficulty, they often cannot speak without halts, stumbles, and agonizing frustration. This 1841 description of a stuttering 13-year-old boy vividly captures a severe case:
His face became distorted; the alae of the nose worked convulsively; his lips moved quiveringly up and down; his eyelids were expanded into a wild and eager stare; the tongue was now stiff, now played convulsively within the mouth; and the muscles of the throat, larynx, and trachea were sympathetically affected. Thus, after terrible efforts, the boy gave utterance to a mangled and imperfect word.
Stuttering is an ancient affliction. A Sumerian cuneiform, dating from 2500 BCE, contains a prayer for deliverance from the malady. A Chinese poem from the Han dynasty mentions it. Demosthenes (384-322 BCE) famously treated his stuttering by yelling over the thundering surf and talking with his mouth full of pebbles. Moses asked God not to choose him as a leader, since he was “slow of speech and of a slow tongue.” In the Koran, Moses begged the Lord to “unloose the knot of my tongue.” God could part the waters of the Red Sea, but he wouldn’t cure Moses’ stuttering, so brother Aaron did the talking for him.
About five percent of humans stutter as children. Most of them grow out of it, but one percent remain disfluent. For unknown reasons, four times as many males as females remain life-long stutterers. One compelling piece of evidence that this is an organic brain disorder rather than a cultural artifact is that it is a global phenomenon. The world population is approaching 7 billion people, and approximately 700 million of them stutter. In the United States, that one percent comes to over three million people.
Barry Guitar is one of them. Like many children, he began to stutter at three. Untreated, he developed secondary habits to try to cope with it. “When you’re a stutterer,” he explains, “the experience is so vivid. Not knowing when a stutter is going to take hold is the most terrifying thing” So he began to interject “um” into his speech. “My friends in fourth grade counted my ums in one sentence and handed me a piece of paper with 17 on it.” Guitar’s stuttering got much worse in high school. To break his oral blocks, he sometimes bobbed his head or blinked. He sucked on hard candies, since that seemed to make him more fluent. He found that if he didn’t shower after gym class, for some reason it eased his stuttering, so he opted for embarrassing odor over embarrassing speech.
Today, Barry Guitar has conquered his stutter – mostly. You can still hear a few hesitations, but he glides out of them, using methods he learned from Charles Van Riper, a pioneer in the field of stuttering, when as an undergraduate he took a leave from Dartmouth. Guitar, 69, is a professor of communication sciences and disorders at the University of Vermont, where he runs a clinic for stutterers. He is also the author of Stuttering: An Integrated Approach to Its Nature and Treatment, now in its third edition, and he espouses an approach called the Lidcombe method that promises to cure stuttering in children if they are treated before the age of six. For older clients, he uses a combination of other approaches.
There may be no outright cure for school-age and adult stutterers, but their affliction can be modified and tamed, so that it no longer rules their lives, makes them regard the telephone as an instrument of torture, affects their career choices, makes dating difficult, and creates mental stress akin to post-traumatic stress disorder.
Blocked will use the life and teaching of Barry Guitar as a narrative spine on which to hang a book of popular science about the mystery of stuttering. What is perhaps most fascinating about the handicap is that, while it is clearly of organic origin, it has a major psychological, cultural component. Throughout much of the 20th century, Freudians and other psychodynamic therapists unfairly blamed parents for their children’s stammers, but there is no question that parental and societal reaction to a child’s disfluency can make it worse, contributing to the child’s fear and shame. Part of Guitar’s approach is to make children and adults understand that stuttering is not something to be embarrassed about, and there are ways to fix it or make it much smoother.
In the age of PET scans, MRIs, bioengineering and genetic research, we may be closing in on the organic cause of stuttering. It tends to run in families, and if an identical twin stutters, the other is likely to do so as well. Various genes have been hypothetically implicated. It appears that in stutterers there is something wrong with areas in the left side of the brain (which controls most verbal functions as well as the right side of the body), and that, compared to non-stutterers, their right brains are more active, even when they are speaking fluently.
Historical treatments and theories about stuttering are varied, inventive, and often disturbing, though Blocked will not spend more than a chapter on anything prior to the 1920s. Aristotle hypothesized that the malady occurred when people thought faster than they could speak. Hippocrates recommended blistering the tongue to remove its black bile. Galen’s prescription was gentler, wrapping the tongue in rags soaked with lettuce juice. In the 19th century, a flurry of tongue surgeries (mutilations) attempted cures, with some patients dying as a result.
Modern stuttering science and treatment began when Carl Seashore, the Dean of the Graduate College at the University of Iowa, became convinced that the world needed a specialist in speech disorders. Seashore groomed a graduate student named Lee Travis, who took multi-disciplinary courses in psychology, anatomy, and neurology, earning the first Ph.D. in speech disorders in 1924, and becoming the founder of the field of speech pathology. In 1927, Travis, the newly appointed director of the University of Iowa Speech Clinic, attached electrodes to the scalps of stutterers as well as to normal speakers. His electroencephalography (EEG) studies indicated increased activity on the left side of the brain during speech for most people, but for stutterers, neither hemisphere dominated, or the right side was more active.
Travis concluded that stuttering was an organic brain disorder. Perhaps, he thought, it occurred when left-handed children were forced to become right-handed. To cure it, he tried reversing the process by disabling right-hand use with slings, casts, or other obstructions. Two of his patients, Wendell Johnson and Charles Van Riper, endured this treatment (without success) but went on to become the leading theoreticians in the field. Both Johnson and Van Riper largely abandoned organic brain dysfunction as an etiology. Instead, Johnson blamed cultural influences. A stuttering child “learns to doubt that he can talk smoothly enough to please the people he talks to, mainly his parents,” Johnson wrote.
To prove that stuttering was culturally induced, in 1939 Johnson instituted a study of 22 orphans, ten of whom stuttered He had a graduate student divide them into two groups, with half the stuttering children in each. One group was told that they spoke fine; if they had a slight stammer, they would outgrow it. The others were told that they had severe speech problems. “Don’t ever speak unless you can do it right.” Although the study failed either to cure or produce stutterers, it traumatized the children in the second group, creating life-long emotional scars.
Charles Van Riper also believed that stuttering was exacerbated by early childhood experiences. He taught that the worst aspects of stuttering are caused by learned behaviors and attitudes that must therefore be unlearned. Fear, avoidance, struggle, and shame are the four primary characteristics of the confirmed stutterer, and they must be reduced or eliminated. Van Riper concluded that advanced stuttering couldn’t be cured, but that people could be taught to stutter as smoothly as possible, and he developed a battery of verbal tools and tricks such as cancellations, pull-outs, and preparatory sets.
Barry Guitar was treated by Van Riper and still uses many of his methods to treat school-aged and adult stutterers. But for preschoolers, Guitar uses the Lidcombe method, named after the suburb of Sydney, Australia, where it originated. Guitar believes that he can produce life-long cures as a result. The method involves simple behavioral conditioning, training parents to be the real therapists.
Since many preschoolers who stutter simply grow out of it, some modern experts recommend a non-interventionist wait-and-see approach, similar to that espoused in 1583 by Hieronymous Mercurialis in Treatise on the Diseases of Children. He advised against treatment before the age of seven, “since before that time it cannot be known whether their speech is defective or not…because it often happens that children stutter up until their sixth or seventh year, and are nonetheless spontaneously cured.”
Guitar is appalled by this approach, since by the time a child has entered school, it is generally too late to effect a real cure. “Whan Stuttynge doth come by nature,” wrote Andrew Boorde in A Breviary of Healthe in 1547, “it cannot be holpen except it be reformed in youth by some discrete tutor.” Boorde was onto something, though older stutterers can in fact be helped later in life, even if they are rarely cured. Most experts now agree that preschoolers should be treated, but some disapprove of the Lidcombe method because it calls attention to the stuttering. Better, say those at London’s Michael Palin Centre (for instance), to pursue more subtle approaches, such as changing parental attitudes and behaviors, rather than making the child self-conscious about stammering.
Blocked will follow two narrative arcs. One features Barry Guitar’s story and his treatment of three patients – Katherine Cook, a pre-schooler who is cured; David Wilkins, an intermediate school-age stutterer; and Sergio Torres, an advanced adult stutterer. The other arc follows stuttering theory from Lee Travis, who believed in the 1920s that the disorder stemmed from an organic brain abnormality, to the focus on psychological and cultural causes, and back to a focus on behavioral approaches and the brain. In fact, stuttering is probably caused by multiple factors, including both biology and psychology. As geneticist Dennis Drayna observes, “Stuttering is one of the great medical mysteries of all time.”
The good news, which combines these two narrative arcs, is that stuttering does not have to be a debilitating, embarrassing problem that ruins people’s lives. It can probably be cured if caught early enough, and it can be effectively treated later in life. There are also lessons we “normal talkers” can learn from those who stutter. Their life stories exemplify how humans can face adversity and overcome it through persistence, resilience, creativity, and humor. The book will also be a call for society to recognize and accept those who stutter – unlike its stereotypical treatment as a joke (Porky Pig, 1935; A Fish Called Wanda, 1988) or a failure of will or courage (The Cowboys, 1972, in which John Wayne admonished a boy: “Listen to me, you whining little whelp, you’re gonna stop that stutter or get the hell out of here.”)
Anyone who has ever felt isolated, misunderstood, or ashamed will identify with the plight of those who stutter. They have formed self-help groups around the world that foster self-esteem and understanding among themselves. The theater group “Our Time” brings stuttering children together to perform with pride. As a result, many have blossomed. “I entered a room where, for the first time in my life, I didn’t feel handicapped, where I didn’t feel like a freak, and where I had absolutely nothing of importance to hide,” wrote one stutterer in Letting Go, the newsletter of the National Stuttering Association, after attending his first self-help convention. “I was with people with whom I instantly felt as one.” Hopefully, Blocked will help to provide that same understanding and relief.
Barry Guitar believes that stutterers tend to be more sensitive than the rest of us – more prone to suffer from taunts or imagined slights, with more pronounced emotional responses. Perhaps this has something to do with a more active right brain, which might also explain why those who stutter are often creative, intuitive, and empathetic. Many are writers, artists, actors, or singers. The novelist Henry James stuttered, as did his father. Writing about the father in 1843, Ralph Waldo Emerson observed: “He confirms an observation of mine, that a stammering man is never a worthless one. Physiology can tell you why. It is an excess of delicacy, excess of sensibility to the presence of his fellow-creatures, that makes him stammer.”
Emerson was wrong about what causes stuttering, but otherwise he was fundamentally right. A stammering man is never a worthless one, and Blocked will be a book worth reading, for all of us who stumble or stutter our way through our tangled lives.
The Market for Blocked: There are over three million stutterers in the United States alone, many of whom will be motivated readers. The book is likely to be promoted by the National Stuttering Association and other self-help groups. (For similar reasons, there should be brisk foreign sales. There are stuttering self-help groups around the world, in Germany, Italy, Japan, Great Britain, and elsewhere. The first international conference of stutterers was held in Kyoto, Japan, in 1986.) Parents and other family members will also want to read Blocked. Those who enjoy well-written, well-researched books about brain research, science, and history will pick up the book. Finally, the same people who flocked to movie theaters to watch The King’s Speech will be moved by the stories in Blocked. Whether we stutter or not, we can all identify with George VI, standing in front of that microphone, looking out on a sea of expectant faces. We have all had that dream in which we get up to talk and find ourselves naked or unprepared.
Similar Books: There are no similar books in print. There are textbooks, including Barry Guitar’s Stuttering: An Integrated Approach To Its Nature and Treatment (Lippincott Williams & Wilkins, 2006, 3rd ed) and a book edited by Barry Guitar and Rebecca McCauley, Treatment of Stuttering: Established and Emerging Interventions (Lippincott, 2010), but they are not written for the general public and most are very expensive. Stuttering: The Search for a Cause and Cure (Allyn & Bacon, 1993), by Oliver Bloodstein, is such a textbook, but it provides a useful history of 20th century research and treatment. There are self-help books, such as Speak Without Fear: A How-To-Stop Stuttering Guide, by Will Clark (CreateSpace, 2010) and Self-Therapy for the Stutterer, by Malcolm Fraser (Stuttering Foundation of America, 2000, 9th ed). The King’s Speech, by Mark Logue and Peter Conradi (Sterling, 2010), is of course about King George VI. Knotted Tongues, by Benson Bobrick (Simon & Schuster, 1995), is the best-written popular book on stuttering, but it is primarily a historical treatment, with the author’s first-person experience patched at the end. The other trade book is Stuttering: The Disorder of Many Theories, a very short book (really an extended essay) by Gerald Jonas (Farrar Straus, 1976). There are a number of excellent autobiographical accounts by stutterers, including Tangled Tongue (University of Toronto Pr., 1985), by Jock Carlisle; Stuttering: A Life Bound Up in Words (Basic Books, 1997), by Marty Jezer; and Stutter (Harvard U. Pr., 2005), by Marc Shell.
Sample Stuttering material to view on the Internet:
“Stuttering: Straight Talk for Teens” (2003), featuring David Wilkins as narrator and Barry Guitar (look at 23:49):
Excellent CBS Sunday Morning TV segment, Jan. 2011: http://www.youtube.com/watch?v=gSuy3JmB0p0
ABC TV segment 1 on Rebecca Glass, with Dennis Drayna, NIH geneticist.
ABC TV News segment 2, Rebecca Glass get SpeechEasy device:
Associated Press video of Erik Yehl, stuttering child:
Local TV show on teen Matthew Reid and SpeechEasy device:
Article on “Our Time” theater group, by Barry Harbaugh:
“A History of Stuttering in the Movies,” by Barry Harbaugh:
Book Schedule and Length: Blocked will take one or two years to complete and will be approximately 100,000 words in length.
About the Author: Mark Pendergrast has written numerous books that have been recognized as the most comprehensive works in their respective fields. Noted for tackling challenging subject areas and writing about them in a graceful, accessible style, Pendergrast says (only half-joking) that he should have earned an honorary Ph.D. in epidemiology, public health, astronomy, physics, business, economics, renewable energy, psychology, and international relations for his disparate works. See www.markpendergrast.com for detailed information on his books.
Blocked: The Frustrating Mystery of Stuttering
by Mark Pendergrast
Introduction: Around 5% of the world’s human beings stutter at some time in their lives, and 1% (about 700 million people) remain affected for life. Many famous people have stuttered, from Demosthenes and Moses to Winston Churchill, King George VI, Marilyn Monroe, and James Earl Jones. King Charles I was cured when he was beheaded. The handicap is cross-cultural, has a strong genetic component, affects men more than women, and apparently involves deficits in the left side of the brain. Yet it also involves a strong psychological component. Stress and shame contribute to the worst stuttering. This book explores the history of the malady, the science as far as we know it, and various treatments (some misguided and unethical), but the main narrative thread focuses on speech pathologist Barry Guitar and his controversial claim that stuttering can be cured (not merely ameliorated) if caught early enough. The introduction mentions several other major historical figures as well, such as Pierre Paul Broca, Lee Edward Travis, Charles Van Riper, and Wendell Johnson.
Chapter 1: Bumps and Smooth Talking. Introduces Barry Guitar, a professor at the University of Vermont and the author of a major textbook on stuttering. The chapter features his initial treatment of three-year-old Katherine Cook (and her parents) at his clinic in Burlington, Vermont. You-are-there journalistic description of the parents, child, and Guitar. The parents explain that Katherine becomes so frustrated by her stuttering that she sometimes cries out and hits them. Guitar calls the child’s stutters “bumps” and assures them that they can be stopped. He explains the Lidcombe method, in which the parents spend 15 minutes a day in structured lessons with the child, using positive reinforcement for “smooth talking” while treating the stutters as mild “bumps” along the road – acknowledging them, but not treating them as a big deal. Guitar’s own stuttering is so well under control that it is scarcely noticeable. He discusses The King’s Speech (movie and book), which he liked except for the Freudian slant. He explains the bitter divide over treatment approaches. He laments a 2011 editorial about the movie in Nature by British experimental psychology professor Peter Howell, in which Howell advised against early treatment for stuttering. The chapter ends nine months after Katherine’s first treatment. She comes to the clinic less and less often. By the time Katherine enters kindergarten, no one can tell that she ever stuttered. She is now 14.
Chapter 2: Not My Brother’s Namer. Flashback chapter to Barry Guitar’s stuttering childhood. “Getting blocked and jammed up makes you feel totally hopeless, like facing an infinitely tall brick wall,” he explains. As a child, like most confirmed stutterers, he learned to use escape behaviors, such as blinking, nodding, and saying “Um,” or avoidance behaviors such as choosing an alternate word or not speaking at all. When he was eight, and had just moved to Charleston, South Carolina (his father was transferred there as a naval officer), an elderly neighbor yelled across the street to ask his brother’s name. Barry tried to say “Lenny” but got stuck on the L, his tongue seemingly glued to his palate, so he blurted out, “I don’t know!” His fifth grade teacher admonished him, “If you didn’t talk so fast, you wouldn’t stutter.” He thought, What are you talking about? His elementary school disfluency wasn’t so bad, but when the family moved to Old Lyme, Connecticut, just before he started 8th grade, the move to a new town and school, along with the travails of puberty, made him much more self-conscious, and his stuttering got progressively worse through high school.
Chapter 3: An Ancient Malady and Attempted Remedies. Brief chapter on the fascinating history of stuttering, theories, and treatments up to 1920. As Francis Bacon noted in 1627, “It [stuttering] is an Affect that it cometh to some Wise and Great Men.” Famous stutterers include: Demosthenes, Moses, Aesop, Roman Emperor Claudius, Caedmon, King Charles I, Robert Boyle, Cotton Mather, Moses Mendelssohn, Erasmus Darwin, Charles Darwin, Lewis Carroll, Henry James, Clara Barton, Winston Churchill, King George VI, W. Somerset Maugham, Marilyn Monroe, Jimmy Stewart, James Earl Jones, John Updike, Carly Simon, Edward Hoagland, Tiger Woods, Jack Welch. In Isaiah 32:4, on better times to come: “The heart also of the rash shall understand knowledge, and the tongue of the stammerers shall be ready to speak plainly.” Treatments: Roman physician Cornelius Celsus prescribed dunking the head in cold water, eating horseradish, and vomiting. Various treatments of the tongue, from Roman times to the 18th century: blistering, cutting the frenum, slicing wedges from the tongue. Other surgeries: adenoid/tonsil removal, widening the dental arch, trepanning the skull. In 1817, Jean Marc Itard put a little golden fork under the tongue. Other devices with springs, spokes, and clamps to be put in the mouth or over the face. Bloodletting, cathartics, searing irons to the lips, faith healing, hypnosis, ingesting insect repellent. Psychoanalysts diagnosed repressed traumas, anal retentives, oral nursing fixations, and “primal sexual pleasure.” Girl stutterers’ tongues demonstrated penis envy. But such insights did not cure. More effective, but temporary cures: rhythmic speaking while foot stomping, finger snapping, swinging dumbbells; drawling, droning, whispering, singsong speaking.
Chapter 4: The Earth Moved. Barry Guitar’s young adulthood and first successful stuttering treatment. By the time he was a senior in high school, Guitar was acutely self-conscious and ashamed of his severe stutter. At a New Year’s Eve party, his sister introduced him to a friend, who commented, “Oh, that’s really interesting,” about the stutter. “The earth moved,” Guitar recalls. “He treated it like a normal thing. It just lifted me.” In the spring of 1961, as a sophomore at Dartmouth, Guitar took a year off to study with Charles Van Riper at Western Michigan University. Van Riper, a legendary, hard-charging, no-nonsense teacher in the mode of Lionel Logue of The King’s Speech, put a set of head phones on Guitar and had him talk while paying attention to what his lips and tongue were doing. Guitar heard himself speaking with a slight delay, which can cause normal people to stutter, but it helped Guitar become more fluent. Van Riper believed in being aware of your stutter, studying it, and confronting it. He ordered Guitar and other students to approach ten total strangers and greet them as if they were old friends, to increase confidence and desensitize them to their phobic avoidance of stressful speaking situations. Van Riper believed in voluntary stuttering – deliberately exaggerating a stutter. Don’t fight it or fear it.
Chapter 5: The Two Patients of Lee Edward Travis. The lineage of Barry Guitar’s stuttering treatment (and that of his own students) goes back to Lee Edward Travis, the father of modern speech pathology, who set up a laboratory at the University of Iowa in 1927 to study stuttering. He attached electrodes to his patients’ heads and determined that, compared to normal speakers, their right brain activity was higher, especially when they stuttered. Travis concluded that disfluency stemmed from an organic brain disorder. He also found that a disproportionate number of stutterers were left-handed, implying right brain dominance. Hypothesizing that stuttering might be caused by forcing lefties to become right-handed, he disabled the right hands of his patients to force them back to their left-hand dominance. But that didn’t cure the stammerers; it just further traumatized them. Two such patients, Charles Van Riper and Wendell Johnson, went on to become renowned experts on stuttering. Both rejected the hypothesis of organic brain disorder. Van Riper developed his behavioral methodology, while Wendell Johnson pursued evidence that stuttering was due to psychological trauma. For decades, the pendulum swung towards the study of social factors that might cause the handicap.
Chapter 6: On the Road and All at Sea. By December 1961, after working with Charles Van Riper for six months, Barry Guitar was fluent, with hardly a trace of a stutter. Over Van Riper’s protestations, he quit. “I needed to go out and see if it lasted.” Guitar stuck out his thumb. As the first car that picked him up drove out of Kalamazoo, he began to stutter again. Determined to persevere, he hitchhiked around the country for the next year, taking odd jobs in Florida and then as a waiter in New Orleans, where he refused to take orders from a fellow waiter and got into a fist fight. The other waiter turned out to be a former Golden Gloves champion, and the feisty Guitar, who stood 5’ 5” and weighed 115 pounds, was badly beaten but unbowed. He was fluent enough to join the Merchant Marines (“they were replacing old drunks with young drunks”) and shipped out on a freighter to Africa, steaming up the Congo into Conrad’s Heart of Darkness, where he lost his virginity to a prostitute. Back in New Orleans, he fell in with bohemians, ate peyote buttons, and shipped on a freighter to Europe. “I was just hanging out, sowing my wild oats.” But he was beginning to stutter more. After a year, he wrote to Van Riper to ask if he could return. The professor shot the letter back, scribbling on the bottom, “Yes, if you’ll let me help you.”
Chapter 7: Too Late for David? This chapter jumps back near the present, where we meet first grader David Wilkins, who has a severe stutter. The Lidcombe method is unlikely to cure him, since he has already got an ingrained stutter with secondary characteristics (escapes, avoidances). For David, Guitar draws on lessons he learned from Van Riper. But progress is slow for the first year, as David resists talking about his embarrassing stutter and is reluctant to try to modify it. During the second year of therapy, a local television station films Guitar working with David. Being on camera makes David more willing to work on his stuttering. He proudly shows the video to his second-grade class, sharing some of his experience in speech therapy. After that, progress is slow by steady, with Guitar bribing David with candy for good “slideouts” from stuttering. Today David speaks with only minor stuttering, and as a teen, he testified eloquently before the state legislature about the need for more funding for treatment of school-age stutterers.
Chapter 8: Fuller Brush Man. Back in Kalamazoo in 1963, Barry Guitar worked as a Fuller Brush man while studying with Charles Van Riper for another year. His job made him speak to strangers every day, but he also forced himself into even more stressful speaking situations. “I would go into a restaurant and make up a story about someone with license plate Z654Q blocking my way. I would stammer it out, and they would just stare at me, obviously thinking, Who is this madman?” Gradually, he overcame his fear so that he could “transfer” what he learned with Van Riper into the real world. He learned to move through words deliberately rather than forcing them out. In the middle of a block, he would pause, stay in the posture of it until he loosened up, and proceed. Van Riper encouraged Guitar to adopt a pet crow, teach it to talk, then traumatize it to see if he could get it to stutter. Guitar couldn’t bring himself to teach Mary, the crow, to talk, which involved covering her cage, much less bring himself to traumatize her. Mary eventually flew the coop, and so did Guitar. This time, he really was much more fluent, though not cured.
Chapter 9: Blaming the Parents. Meanwhile, Wendell Johnson, who had roomed with Charles Van Riper during the days when their right hands were bandaged in the 1930s, had succeeded Lee Travis at the University of Iowa, where he was a charismatic teacher and influential theoretician. When he asked mothers to recall their children’s first stutters, they mentioned pauses and repetitions that sounded similar to ordinary children of the same age. Johnson surmised that the children were ordinary until their parents made them self-conscious and afraid. “Stuttering begins not in the child’s mouth, but in the parent’s ear,” he concluded. The malady was purely psychological. Why then did it run in some families? Because parents were hyper-vigilant in monitoring and correcting their children’s disfluencies. In other words, it was the fear of stuttering that in fact caused stuttering. Johnson’s theory led to what is now called his 1939 “Monster Study,” in which non-stuttering orphans were told that they had severe speech problems. Some of them developed mild disfluencies, but they were all severely traumatized. Johnson also relied on flawed anthropological evidence that the Native American Shoshone and Bannock, who practiced permissive childrearing, did not stutter and had no word for the handicap. That turned out not to be true. While it led to some useful research and insights, Johnson’s theory, which predominated during the Freudian 1950s and 1960s, has been debunked.
Chapter 10: Finding a Vocation. In 1964, Barry Guitar received his draft notice. He quickly re-enrolled at Dartmouth in order to get a student deferment. Van Riper arranged for him to work at a summer camp for handicapped children in North Dakota. “It was the first time I did therapy with kids who stuttered, and I had a ball. I could see that I made a difference, and I thought, Maybe they won’t have to go through what I went through.” After earning a masters degree in speech pathology in 1967, he spent two years as a speech pathologist for black kids in the inner city of Washington, DC, in the middle of the race riots following the assassination of Martin Luther King. He and his students would go into a local candy store to desensitize them to fear and to practice voluntary stuttering. “We would order candy, terrify the clerk, and come out of the store laughing like crazy.” Guitar joined the D.C.-based Council of Adult Stutterers, one of the first such self-help groups. But Guitar decided he needed to learn more to really help the children, so he went to the University of Wisconsin for his doctorate, writing his dissertation on biofeedback for stutterers to help them relax facial and throat muscles before speaking. While there, he married his long-time girl friend Carroll. The ceremony was performed by fellow stutterer and friend Cotton Fite, an Episcopal minister. Guitar graduated in 1974, then spent two years in Australia working on a behavioral “fluency-shaping” program in which clients began speaking very slowly, then gradually spoke faster. During the three-week intensive clinic, most clients became fluent, but Guitar discovered that many of them relapsed in a few months. In 1976, touring Africa with wife Carroll for a few months, he began to stutter again. He then returned to the United States to teach at the University of Vermont, where he has been ever since.
Chapter 11: The Cures. As Barry Guitar began to teach and work in the speech clinic at the University of Vermont, his stutter worsened. “How can you talk to parents when you yourself are stuttering?” a colleague asked. His students suggested that they use fluency shaping on him, since he kept talking about it, and Guitar agreed to a two-day intensive experiment in which he told jokes – an exercise guaranteed to make him stutter. It was a break-through experience. He realized that by combining Van Riper’s techniques with fluency shaping, he could help himself as well as others. Eventually, this led to his writing a textbook on integrated treatment of stuttering, published in 1991. (More on origins of fluency shaping here, deriving from delayed auditory feedback. In 1949, electrical engineer Bernard Lee discovered by chance that listening to himself speak with a slight delay made him stutter. When he published an article on it, someone tried delayed feedback on stutterers, and, amazingly, instead of making them stutter more, it made them fluent by slowing them down.) Like most other speech therapists, Guitar used a “parent-interaction” model to treat preschoolers, never directly addressing the stutter, but getting the parents to take the pressure off the child by ignoring his disfluency and modeling slower speech. Then, as an associate editor of the Journal of Fluency Disorders, Guitar read papers about the Lidcombe method of direct therapy for preschoolers, written by Australian Mark Onslow and his colleagues. He tried it on a young boy and “Bingo! It worked like magic.” His second client was Katherine Cooke (see Chapter 1). This chapter also covers other “cures” for stuttering, including fluency shaping as promoted by Ronald Webster at Hollins College in Virginia and the “air flow” method of the self-promoting Martin Schwartz, who wrote Stuttering Solved (1976). The Schwartz method teaches people to relax their vocal chords with a passive outflow of breath before speaking. The chapter also also reviews the SpeechEasy delayed auditory response device, which resembles a hearing aid, and drugs such as risperidone and olanzapine, anti-psychotic agents that block dopamine. Excess dopamine appears to be related to stuttering.
Chapter 12: Sergio’s Odyssey. Story of Sergio Torres, an advanced stutterer in his thirties who comes for treatment with Barry Guitar. Sergio has stuttered since he was three. Eight of his maternal aunts and uncles stuttered. As a child, Sergio could speak fluently much of the time, but when excited or hurried, he stuttered badly. In response, his father would hit him on the head with his knuckles. His parents took Sergio to a hypnotist and a psychotherapist who prescribed tranquilizers. Neither helped. During his elementary and junior high school years, he was ridiculed by classmates and teachers. In high school, he learned to play the guitar and could sing Beatles songs fluently. He dropped out of school, performing in a band and taking odd jobs. He could speak fluently during performances, making funny comments between songs, but otherwise Sergio stuttered terribly, grimacing and making strange starter sounds to fight his way through his blocks. He avoided phone calls. With Barry Guitar’s therapy, and with support from a self-help group of fellow stutterers, Sergio has made dramatic progress and now takes pride in his “easy stuttering.” He and other stutterers, who call themselves “The Amigos,” enjoy coming to Guitar’s classes on fluency disorders to demonstrate their proficiency.
Chapter 13: How Come They Can Sing, Whisper, Curse and Act, But They Can’t Converse? This chapter covers the confluence of multiple factors that apparently cause stuttering. Lee Travis was right after all. It probably stems from a right brain disorder of some kind, and several specific areas of the brain (Broca’s, Wernicke’s area) and various genes have been tentatively implicated. These include genes on chromosomes 1, 13, 16, 18, and a specific gene. FOXP2, that appears to be involved in speech. Twin studies and other such epidemiology indicate a genetic defect. Barry Guitar suspects that there are several genetic pathways that can lead to stuttering. Yet there is also clearly a huge psychological component. Many stutterers become fluent when they sing, speak in unison or with an accent, whisper, or act. Give example of Taro Alexander’s “Our Time” theater group here. Perhaps when they become someone else they are not so self-conscious. Give example of Pendergrast hearing John Moore, a dynamic young speaker, at a conference, and realizing that he had a very slight stutter. Afterwards, in casual conversation, Moore stuttered badly, as do his father and twin brother. This chapter also covers research on stuttering currently being conducted by Barry Guitar at UVM, Anne Smith and Christine Weber-Fox at Purdue, Ehud Yairi at the University of Illinois, Peter Ramig at the University of Colorado, and Dennis Drayna at the NIH, while raising ethical issues about experiments on child stutterers that do not attempt to treat them. The chapter’s conclusion: stuttering remains a mystery.
Chapter 14: What We Can Learn from Stuttering. Concluding chapter, with quotations from different experts and theoreticians, including Barry Guitar. Explanation of how normal speakers can become more sympathetic and attuned to the frustrations of stutterers. (For instance, try saying the word “by” without opening your lips.) Guitar compares a stutter to driving a car that keeps stalling in traffic. “Sometimes it splutters and jerks when you pull away from a stop sign. Other times it drops into neutral, so the engine races but the wheels don’t turn. Still other times, the breaks jam by themselves and won’t release until you stomp repeatedly on the pedal.” It isn’t surprising when the driver becomes fearful every time he drives the car, or avoids using it altogether, especially when other unsympathetic drivers honk or yell. It is amazing what those who stutter can accomplish in their lives, despite their handicap. Give examples here. As the movie The King’s Speech so movingly demonstrated, it takes courage and persistence to live an effective life. We are all of us stutterers in a way, with our own insecurities, handicaps, and challenges. We can learn some of the same lessons that those who overcome their stuttering must learn – patience, slowing down, learning to love ourselves despite what others may say or do. Guitar thinks that those who stutter tend to be the most sensitive among us, and a right-brain dominance may contribute to a more creative, artistic side. Thus, all of us humans, however we speak, may benefit from listening more closely to those who are, like Moses, hesitant of speech.