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From: Darrell Dodge
Date: 10/17/02
Time: 2:14:21 PM
Remote Name: 172.195.132.128
Hi Nathan:
Thanks for your response, which clarified your view of the role of emotion in stuttering. It seems to me, though, that you're limiting this role to the aspect of emotion that relates to conscious *feelings*. This is something that unfortunately confuses many people who stutter, who may not feel excessive fear or anxiety about their stuttering, but still experience a lot of dysfluency and, as a result, discount the "emotional" nature of the disorder. Unfortunately, this confusion is apparently shared by some clinicians.
The amygdala is much more than a "relay." It has been shown to work with the hippocampus to evaluate situations for emotional significance and -- of particular relevance for stuttering -- for possible survival threats (in the presence of which it mediates alarm-related behaviors), and also to associate these threats, through conditioning, with responses, reactions, and alarm behaviors. For example, when a child who is having difficulty with fluency sees a look of fear, anger, anxiousness or shock on the face of a listener, this threat system associates all aspects of the experience/situation and records it as a significant event. These memories are apparently stored in the amygdala, as well as in the other distributed memory areas in the cortex and elsewhere. Such memories, if they are significant enough (and particularly if they are created early in life), are virtually permanent.
From another perspective, clinical experience indicates that the triggering of stuttering involves much more than just "anticipatory anxiety." We know this because stuttering events can be instantaneously triggered in the midst of fluent utterances when the speaker consciously or unconsciously uses excessive articulatory tension or force. This doesn't require any anticipatory emotion, it just requires the stutterer's "watchfulness," for the possibility of stuttering, which is mediated by the amygdala and is, thus, virtually automatic and unconcious (and largely independent of "anticipatory anxiety," as you note). Apparently, Because the excessive tension or force has been associated with the stuttering reaction through conditioning, the presence of the tension or force alone is sufficient to create a full-blown stuttering event, including the associated perceptions of loss of control and helplessness. This emotional reactivity can be observed to happen virtually instantaneously. (This is perhaps one reason why many people who use self-help "voluntary stuttering" or "bounces" report that these techniques "don't work.")
It occurs to me that, as a psychiatrist, you are probably well aware of these concepts and that their complexity is just outside the scope of your paper. Still, I think it's important to note the other important elements of emotion and their possible role in stuttering.
Thanks again.
- Darrell Dodge, M.A.