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From: Nathan Lavid
Date: 10/21/02
Time: 7:14:05 PM
Remote Name: 66.171.53.24
Hello Darrell,
I apologize for the delay in responding to your comments. I did not notice them until now.
One of the things Judy stressed to me, and I imagine all contributors, was that the articles were to be targeted to the layperson. Hence, the simple, four-sentence discourse of the relationship between anxiety and fluency. Also, the focus of my article is brain plasticity.
As you mention, the relationship between anxiety and fluency is more complex that what I presented. Though, I’m not sure what I’ve written that implies that I believe that emotional aspect of stuttering is limited to conscious thought. I do not take this viewpoint, nor is it is considered part of contemporary psychiatry. I use the term “anticipatory anxiety,” to describe the anxiety associated with the anticipation of dysfluency. There is no connotation regarding conscious or unconscious thought intended with this term.
Though, I can expand on the idea of unconscious thought and its relation to anticipatory anxiety. To avoid confusion, I’ll define what I mean by unconscious thoughts. Unconscious thoughts are simply thoughts we are not aware of. This is in contrast to conscious thoughts and differentiated from a neurological unconsciousness, which is gradations of coma.
The expression of anticipatory anxiety requires the revisiting of memories, and memory is primarily an unconscious processes.
Psychiatrists differentiate long-term memory (which is more involved in stuttering than immediate or recent memory) into two systems that work together. Declarative or explicit memory is a conscious memory for people, objects, places, facts, and events. This memory requires the hippocampus and medial temporal lobe for its expression. Simply, declarative memory can be thought of as a memory for what things are.
Procedural or implicit memory is unconscious and involves emotional responses, motor skills, and behaviors. Procedural memory depends on motor and sensory areas of the neocortex, components of the limbic system, such as the amygdala, the cerebellum, and the basal ganglia. This type of memory is only evident in performance and activity as opposed to the conscious recall of declarative memory and is basically the memory for how to do something.
Repetition is how these systems work together and results in the transformation of declarative memory into procedural memory. The classic example of this transformation is the process of learning to drive a car. The initial conscious recollection of how to drive a car becomes an unconscious activity with repetition.
This same type of process is thought to contribute to the expression of anticipatory anxiety. Anticipatory anxiety is a result of stuttering and is cultivated by previous awkward social situations where one has felt embarrassed stuttering in the presence of others – a conscious thought process. Over time, repetition transforms these memories to the procedural type – an unconscious thought process.
Being unconscious, however, does not make anticipatory anxiety permanent or untreatable. I presented the concept of brain plasticity, in part, to give encouragement to those who stutter and provide some understanding how therapy can change the structure and function of the brain. This change can occur whether the mental processes are conscious or unconscious.
I hope this was helpful. Again, I apologize for the tardiness and thank you for the comments. Nathan