ATTEMPTS AT CORRECTION
Approaches to the treatment of stuttering have been extensive. Hundreds
of books and thousands of articles have been published on the subject in
the last half century. Certain techniques occur repeatedly in the literature;
they occur because they have been partially successful.
Relaxation Therapies. These have by far been the most prevalent set
of approaches to treating stuttering. There are several varieties, but
in all the aim is to reduce muscle tensions throughout the body, and thus
elude the stutter reflex. In one approach, patients are encouraged to start
by focusing on a specific muscle group (usually the toes), contract it
maximally to heighten awareness of the tension, and then relax it as much
as possible. Each muscle group is addressed separately until the entire
body is relaxed. This procedure, known as Progressive Relaxation, was first
described in 1923 by Edmund Jacobson, and has been employed frequently
for the treatment of stuttering. The reported results indicate improvement
but never total success in eliminating the problem.
Another type of relaxation involves yoga-derived stretching exercises.
In these attention is drawn to increasing flexibility of the spine and
involve twisting, rotating, and bending the torso. Performed slowly and
in a deeply meditative state, these exercises gradually bring their practitioners
a more tranquil demeanor - the result again being improvement, but not
Guided Imagery is another relaxation technique that has been
employed to treat stuttering. Patients are trained to imagine a restful
scene or tranquil activity and then encouraged to dwell on the image periodically
throughout the day. This technique produces substantial relaxation in some
patients, again with its attendant improvements in speech.
Finally, there are the biofeedback approaches. Electrodes are
attached to various muscles (usually on the neck) and the degrees of tension
developed during speech are registered on a meter. Patients are trained
to lower tensions by attending to the meter as they attempt to make the
level decrease. Unfortunately, the findings with biofeedback have been
disappointing since the stuttering, following treatment, rarely improves.
In summary, it appears that relaxation approaches tend to improve or
reduce stuttering, but not stop it. They simply do not subtract enough
tension from the vocal cords.
Deep Breathing Exercises. It is felt that breathing deeply before speaking
stops stuttering. Based on this premise, some therapies teach a variety
of deep breathing exercises. A few of these techniques stress breathing
from the diaphragm while others stress the ribcage. Some talk about the
importance of nasal breathing, others, oral. The justification for the
exercises is the often-noted observation that the breathing patterns of
stutterers are disturbed. Unfortunately, most of the experimental studies
have shown no improvement.
Speaking Exercises. Employing a novel way of speaking as a method for
treating stuttering has been used frequently. For example, some therapists
have advocated using speech timed to the rhythm of a metronome while others
have suggested using what is best described as a sing-song voice. Some
require their patients to speak softly while others require them to shout.
Still others have suggested that the pitch be raised, while just as many
are equally emphatic about the importance of lowering pitch. Some have
insisted that speech with a foreign accent is a solution and others advocate
speaking as they inhale. Some suggest hardly moving the mouth while speaking
while others suggest whispering.
The outcome of the survey of these often contradictory approaches is
a set of largely ineffective treatments. This is not to suggest that novel
ways of speaking do not produce fluency, on the contrary, they often do.
But they are ineffective as a form of therapy because patients reject them.
They are perceived as alien; they are not normal. Patients may not like
stuttering but at least they are used to it. They are not used to talking
in a manner which they and others perceive as strange.
For example, it is known that every stutterer in the world will be fluent
if he sings. But show me a stutterer who is willing to break into song
every he wants to communicate. It is just not acceptable. The Country-Western
singer, Mel Tillis, has made a career of juxtaposing a totally fluent singing
voice against the difficulty he experiences whenever he tries to speak.
He does this in a humorous vein and has his audience laughing along with
him at the incongruity.
It has also been well documented that one can stop stuttering by speaking
slowly. Proponents of this approach are known as the Controlled Rate Group.
These therapists claim that the reason slow speech helps stuttering is
that it allows the brain time to compensate for some presumed but unspecified
incoordination among the respiratory, vocal cord and articulatory mechanisms.
One method commonly employed for slowing speech is called Delayed Auditory
Feedback. Patients speak into a microphone which is attached to a tiny
computer which records, delays, and sends amplified speech to earphones.
The patient hears his speech delayed by approximately .2 second. Speaking
under such conditions is difficult; one tries continuously to adjust or
compensate for the delay.
It turns out that the only successful way to compensate is to slow the
rate of speaking. While the slowing reduces or even eliminates stuttering,
the price one pays, apart from the obvious slowness of the speech, is the
obtrusiveness of having to speak into a microphone, wear a computer and
have earphones on all the time.
In another method a tiny electronic metronome is inserted behind the
ear. The speed of the metronome can be adjusted as the person speaks, so
he is required to time his syllables to the rate he heard in his ear. Providing
the beat is slow enough, this Syllable-Timed Speech, as it is called, produces
fluency. But again, the price paid is unnatural sounding speech and dependency
on an electronic device.
Proponents countered by saying that patients could gradually increase
the speed of the metronome, and when it was sufficiently rapid, the speech
would sound normal and the patient could then discard it. The experience
of stutterers, however, contradicts this: as the rate is increased, stuttering
Punishment. As a form of treatment, punishment has a long history in
the therapy for stuttering. For example, electric shocks have been and
continue to be employed to create unpleasant stimuli. No one likes a shock,
however mild it may be, and a patient will do anything to avoid one.
But the psychology of learning tells us that people learn because they
are rewarded, and a shock is punishment, something to be avoided. Patients
do whatever is necessary to avoid getting shocked, whether it means changing
the pitch of their voice, swallowing, coughing, speaking slowly or sounding
as unnatural as they can. But this does not mean that they learn
these techniques. As soon as the shock is removed they quickly revert to
Another form of punishment used with stutterers was carbon dioxide treatment.
Breathing CO2 has been used to treat depression and other mental problems.
It was often used as a substitute for electro-convulsive shock therapy.
A patient in her early sixties reported being forced to breath CO2 as a
child. She recalled being taken every morning by her father to a doctor
who would administer pure CO2 through a face mask. After two breaths she
would pass out and, when revived, be driven to school. This went on for
a year and a half without any positive effect on her speech, and the memory
of this daily torture has remained vividly etched in her mind for over
half a century.
Surgery, while not necessarily punishment, had the same effect. Surgical
approaches were employed in Europe in the middle of the nineteenth century
and still continue today, albeit to a much lesser extent. For example,
if one lived in Germany in 1842 there was a good likelihood that a stutterer
would have had a portion or all of his tongue removed. (Bear in mind that
this was before the advent of anesthesia). Surgeons pursued this course
for almost fifteen years before they decided it was ineffective.
Even today, one sees well-meaning physicians suggesting that the cause
of stuttering is tongue-tie and that the problem can be cured by the simple
expedient of snipping the small piece of tissue they feel tethers the tongue
to the floor of the mouth. Unfortunately, there is no evidence that this
approach has any positive effects upon speech what-so-ever, and one can
only hope that the practice will cease.
Drugs. The last area of treatment for stutterers has to do with the
administration of drugs. There are three basic types. The first are the
anti-convulsants. Neurologists see the violent struggle behaviors associated
with stuttering and feel that they constitute a form of convulsive seizure.
But lacking training in learning psychology, they fail to understand that
such struggles are learned. The medical literature is filled with published
reports of the merits of one anti-convulsant drug over another for the
treatment of stuttering. The fact that the vast majority of patients do
not stop stuttering and that the side effects of the drugs are often serious
does not seem to dissuade neurologists from pursuing this treatment.
The second class are the tranquilizers. There are a number of these
and all, in one way or another, have been tested. Many are useful in reducing
overall stress. But again, they do not completely eliminate the problem
and their side-effects can be substantial. Recently tested are a new family
of tranquilizers called Beta-Blockers. These show promise and further research
is under way.
The third group are the muscle relaxants. If tension is the ultimate
source of stuttering, it makes good sense to investigate any approach that
reduces tension. However, it appears that the amount of any drug necessary
to reduce vocal cord tension is so great that the side effects are invariably
unpleasant and unsafe.
It is clear that there has been great interest in methods for treating
stuttering. Most bring at least some relief to a significant percentage
of stutterers. But none solve the problem completely, and that ultimately
creates their downfall. It's very much like cancer. You remove ninety percent
of the cancer and the other ten percent does you in. Unless you can eliminate
all of the stuttering, the residuum with eventually create the inevitable
relapse. Also, if the price you have to pay for your improvement is speech
which sounds strange or an involvement with obtrusive apparatus, the chance
for fluency is virtually doomed from the start.
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