THE HUNT FOR THE STUTTER REFLEX
How could locked vocal cords produce such varied speech struggles? Speech
therapists I spoke with maintained that the struggles were divisible into
the three categories of hesitations (sometimes called blockages), repetitions
(of words, sounds, or syllables) and prolongations (again, of sounds or
syllables). But this categorization seemed arbitrary and tended to obliterate
many of the apparent differences I observed. Also, it related only to speech,
completely disregarding the non-speech events.
Most speech pathologists nebulously conceptualized stuttering as an
"incoordination" among respiratory, vocal cord, and articulatory mechanisms.
However, the precise nature of this incoordination was never spelled out
and there didn't seem to be research to support it.
Why, if there was an "incoordination," did it disappear when the patient
talked out loud to himself? And why was it not present continuously but
only on certain words?
After reviewing the literature, my feeling remained that the physical
cause of stuttering lay at the vocal cords and that all the other behaviors
seen were a reaction to the constriction of the vocal cords. But the precise
nature of this response eluded me, until one day, quite by accident, I
found an answer.
There is a door in my office through which I pass each day. The procedure
is always the same. I go to the door, put my hand on the doorknob, turn
it, pull the door open, walk through, and the door closes automatically
behind me. It always works, I always expect it to work, and I'm never disappointed.
But one particular day a water pipe broke in the office above me, and
the water seeped slowly through the ceiling and into the wooden door. The
door was swollen and stuck in the door frame but I didn't know it because
it had been a slow ooze I couldn't see it.
So I went to the door, the way I have every day for years, put my hand
on the doorknob, turned it, and pulled. But it didn't move; it was stuck.
My initial reaction was to pull harder, and that didn't work. So I pulled
ever harder, until finally, I wrenched the door open.
Twenty minutes later, I returned to the door and again found it stuck.
I immediately yanked forcefully and it opened.
At that instant I realized I had undergone a conditioning. I had learned,
after just a single trial, some twenty minutes earlier, to forcefully yank
the door. I had learned to struggle.
The swollen door was equivalent to the locked vocal cords, and my tugging
was equivalent to the struggle behaviors of stuttering. The fact that my
initial struggle had resulted in success, that is, the door had opened,
meant that I had been rewarded for my efforts and thus, in the same situation,
would likely struggle again. Which I did.
To relate this to stuttering - John, struggling to say his name (pulling
on the door knob), after a few moments, says it (gets the door open), and
the act of saying it (getting the door open), becomes the reward for the
struggle (the stutter) which enables him to say it.
I now began to suspect that all of the stuttering I observed was learned.
And all of the variety I had noted was nothing less than an eloquent testimonial
to the heterogeneity of human beings learned struggle behaviors against
a common core problem, a spasm of the vocal cords. Here, at last, was the
stutter reflex. All the struggle events were now viewed as extricatory
The pieces of the puzzle were beginning to come together. From my knowledge
of the anatomy and physiology of the speaking apparatus I knew that there
are small nerve endings within the vocal cords that detect tension and
send this information to the brain. When the tension in the vocal cords
builds to a critical locking threshold, these nerve endings issue a particular
pattern of impulses. I now began to understand that it is this particular
pattern of nerve impulses reaching the brain that triggers the stutter
In response to some form of apparent stress (as yet, unspecified), the
stutterer locks his vocal cords; it is an inborn reflex. The locking of
the vocal cords, in turn, triggers stuttering, a learned reflex. So there
are two reflexes - one inborn, the other learned.
I asked a colleague whose specialty was learning psychology if it was
possible that so violent and varied a behavior as stuttering could really
be learned. His response was to show me a film of learned self mutilations
and to point out that most physically aggressive behaviors are culturally
acquired. The struggles I was seeing were mild by comparison. Any behavior
that was rewarded could be learned, and the act of speaking which followed
the struggle was clearly a sufficient reward to enable the learning of
He further pointed out that there was yet another reward commonly present
in most human learned behavior and he suspected it to be present for stutterers
- anxiety reduction. Anything that would reduce a stutterer's speech anxieties
would be rewarded and learned.
I recalled that many stutterers reported that they would often word
substitute rather than stutter. As they spoke they mentally looked ahead
so that they could shift the conversation away from feared words or change
instantly to a word they could pronounce. The successful avoidance of feared
words reduced anxiety, was therefore rewarded and learned. Word avoidance
was as much of a reflex as the stutter itself. Further, in order to avoid
one had to develop the habit of looking ahead and so that, too, became
I learned that the stutter reflex was, in fact four learned reflexes.
First, the overt stutter; second, word avoidance, third, situation avoidance;
and fourth, the habit of looking ahead.
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